Thursday, May 17, 2012

Sex and Massage Part 5: Physiological Response

"If something can go wrong, it will."

- Murphy's law     

Professionally Assess, Compassionately Address

It is a fact that massage can elicit sexual subtext, unintentionally or not, that can lead to a physiological response that are more obvious in men (see also Part 4)! Yes, it happens and yes, it is normal, BUT no one really wants to talk about it! Few if there is, yet to many men, it is one of the primary reason why they avoid therapeutic massage. Truth is, there are times that I myself experience it during a massage therapy session and here I will talk about it - the physiological response that is - not my experience itself! I've included some tips on how you can "professionally assess" a client’s intentions and how you can "compassionately address" this situation.

As Massage Therapists, we are well aware of the evidence-based therapeutic effects of  a particular massage technique or discipline that we use for a particular session AND we are well aware that different individuals (different men, or different sexual orientation among men) can have a different physiological response to that technique. We should never assume that the desired outcome that we or the client want is what we can actually achieve for/with the client. There could be a very different physiological effect on the contrary, and this is something that can happen to you and your client. We should also remember that some physiological effect of our touch is just that - physiological! And these physiological responses can exist without any, I mean NOT ANY underlying ulterior intentions.

It is quite recent that we readily understood the physiological effects of massage therapy on the body's various system through evidence-based research. Aside from the muscular and skeletal system, much of these researches pay particular attention to the effects of massage to our central nervous system and the endocrine system (Erections are very much connected to these two systems by the way). Today, we now understand in some depth and detail the true benefits of massage therapy to the human body, and we can use this understanding both to address our clients' concerns and to predict other less desirable responses (especially among men) so we can also address the situation properly. 

We need to remember that depending on our clients' goal or need and the therapists' skills and knowledge, the desired effect of massage CAN also be a non-desirable effect itself if they go against what our client needs and what we are trying to achieve! This is where our knowledge in  physiology comes in! So, let us look at two of the Laws of Physiology that applies to the situation (as stated in Taber's medical dictionary) to give us some idea of how to "compassionately" address the situation if it happens! Compassionately addressing a client's erection in this case is NOT synonymous to Lingam massage or a happy ending - more on this topic in Part 7 of this series. 

(1) Hiltons Law: "A nerve trunk that supplies the muscles of the joint also supplies the joint itself and the skin over those area, and the attachments of the muscles" - LOGIC: Stimulation of any of these areas, the muscle or skin per se, in turn, affect each part. If the area you need to address, for example, is in the inguinal region, expect the possibility of stimulating any body part on that area that are innervated by the same nerve trunk! In other word, it does not necessarily mean that a male client is sexually aroused when you are addressing the clinical issue on his medial hip flexors; 

And (2) Arndt-Schultz Law: "Weak stimuli activate physiological processes: very strong stimuli inhibit physiological responses" - Logic: Using gentler, softer, slower and more superficial methods are more likely to stimulate the activation of physiological responses, especially those of parasympathetic nature: i.e. erection. Doing deeper, more vigorous techniques on the contrary have the opposite effect. Do you remember the Parasympathetic nervous system? A.k.a. Rest and Digest; a.k.a. SLUDGEM- Salivation, Lacrimation, Urination, Defecation, Emesis (Erection in some books) and Miosis (pupilary constriction). This part of the Autonomic Nervous System respond well to soft, gentler and slower strokes, you can expect some of your client to experience a few or more of the above SLUDGEM. 

Having said the above - tearing, runny nose, feelings of going to the bathroom and yes, erection are but possible physiologic responses to massage therapy that we need to compassionately address! Remember that in spite of the fact that an erection can be indicative of being sexually aroused, it does not necessarily indicate the presence of emotional or sexual desire. The massage that we administer to any part of the body can indeed activate the parasympathetic nervous system, which can result in a partial or complete erection. This is where we perform a complete professional assessment to decipher and distinguish between a physiological response to touch from an inappropriate sexual intentions. 

For those instances that are sincerely "devoid" of inappropriate intentions, our knowledge of physiological responses can ease some fear and invite a new level of comfort between our client and us. If there is any discomfort on the part of either the client or the practitioner when an erection occurs, it must be addressed - the discomfort resulting thereof, NOT the erection. Discomfort on the part of the client or the therapist will divert the focus of the therapy, resulting in decreased effectiveness. If, on the other hand, a man shows no signs of embarrassment or discomfort due to his erection, and the therapist is comfortable, then addressing it is NOT necessary - ignore! NOW, if the therapist notices any client discomfort, such as body tension or facial flushing, then it would best serve the client to talk about it. And because the antidote to a parasympathetic response, as I have mentioned above, is activation of the sympathetic nervous system, changing the technique being used can quell a spontaneous erection. Increase massage pace and pressure. The increase should be moderate and gradual, as it is not intended to alarm or cause pain. 

In this post, many of the opinions on how to handle physiologic responses to massage are my own view based on my previous education and experience, some from my old books (as referenced). I do not guarantee that they will work for any situations, but they can help. Professionally managing human interaction when it comes to a client's erection requires preparedness, maturity and education, for that you may find the 8-Step approach more useful.

- Leo Feraer-Oporto     

 The 8-Step Systematic Approach

If you are still having problem assessing what the client's intent is, here is an 8-step systematic approach to dealing with it based on the book "The Ethics of Touch" written by Ben E. Benjamin, Ph.D. et al:

Step 1: Stop the treatment using assertive behavior: Addressing the client with body language congruent with verbal communication demonstrates assertive behavior:
·    Tips to remain assertive include making eye contact, standing with relaxed, yet grounded posture and using a firm voice.
·    Shrinking or speaking quietly portrays passivity, while yelling or touching inappropriately displays aggression. Avoid both.
·    By adjusting the drape to make sure the client is properly covered, the therapist non-verbally confirms professional boundaries. Additionally, if touch has contributed to a sexually aroused state, adjusting the drape physically stops the cause of stimulation.
·    At this point, maintaining safety is crucial. If the therapist feels intimidated, positioning him/herself with easy access to an exit can allow for safety should the client become actively threatening.

Step 2: Describe the behavior: When encountered with an erection, stating the obvious can be difficult, but clarifies the client’s intent. By describing a behavior, the client knows the therapist is paying attention without passing judgment.
·    Examples of this type of communication are:
·   "I notice you’re tightening your muscle and grimacing when I pass over this area."
·    "I am aware that you made a comment about my appearance, then made a sexual joke and now you have an erection."

Step 3: Clarify the client’s intent: After stating the obvious, directly asking the client what they are experiencing can reveal the meaning behind the erection. Examples include:
·    "Can you tell me what’s happening?"
·    "What are you experiencing?"
Dependent upon the client’s comfort level and their intent, a client’s response may or may not be straightforward:
·    It is important to resist providing an answer for the client, so wait for a clear response.
·    Clarification of the client’s intent allows for the practitioner to render an accurate assessment.

Step 4: Educate the client: During a somatic-based therapy, some recipients experience unexpected emotional and physiological responses. When aware of a client’s concerns, the therapist can share information to educate the client. Examples of educative statements for a client experiencing an unintentional erection are:
·    "Sometimes clients become aroused as a physiological response to touch. It is a normal body response."
·    "It’s natural for some men to have a physical response to massage."
·    "I noticed you had an erection during the last massage. I want you to know that erections are usually just a physiological response to touch and it’s not unusual for clients to have them."

Step 5: Re-state your intent: Safety is re-established by a therapist clarifying the therapeutic contract of the session. Examples of re-instating therapeutic intent are:
·    "It is never my intent to create sexual arousal during a session. If it happens and I’m confident your intent isn’t sexually inappropriate, then I’m comfortable in continuing the session if you are."
·    "I want to make it clear that this is a non-sexual massage. I will end the session if you are looking for something else."


Step 6: Continue or discontinue the session as appropriate: A client with sexual intent or displaying inappropriate behavior necessitates immediate termination of a session:
·    If sexual intent is determined right away, there is no need to employ the previous steps.
·    If a client’s intent remains unclear, establishing conditions may be necessary.
·    An example of establishing conditions is "I will continue with this session, but will stop if your behavior causes me to feel uncomfortable in any way."

Step 7: Refer client to other professionals as appropriate: This step is typically taken after the completion of a session:
·    If in your opinion, the client could benefit by professional help from a psychotherapist, counselor or other medical practitioner;
·    Provide referral information to the client when he is fully dressed and alert.

Step 8: Document the situation: After the client leaves, document the occurrence and obtain supervision or peer support as necessary:
·    Difficult communication with a client can evoke ethical questions and safety concerns.
·    Seeking supervision indicates a commitment to ethics and professionalism.
·    A neutral party can provide a reality check or needed emotional support.
·    Unless you fear for your own or someone else’s safety, client confidentiality must be honored.
·    When documenting the situation, be sure to include all the facts, including your own actions. This is vital should a client ever lodge a complaint.

Resources: (1) Benjamin, Ben E., Ph.D., and Cherie Sohnen-Moe. The Ethics of Touch. Tucson: Sohnen-Moe Associates, 2003; (2) McIntosh, Nina. The Educated Heart Professional Boundaries for Massage Therapists, Bodyworkers, and Movement Teachers. 2nd ed. New York: Lippincott Williams & Wilkins, 2005.

Encountering the male physiological response is a frequent occurrence in the field of massage therapy. And because it is not freely discussed or compassionately addressed, it actually added up to the stigma that haunts Massage Therapy (see Part 1 of the series). Determining the intention behind a man’s erection during a massage treatment serves to maintain professionalism, ensures therapist safety and reduces client embarrassment. Communication regarding client behavior, therapeutic intent and the physiological normalcy of erections allows a therapist to preserve ethical boundaries while maintaining respect for the client - which is very important. The 8-step process I included here are based on established research done by its respective authors, of whom I acknowledge above. If you have corrections or comments on any of the content, mine or not, feel free, they are very much welcome!

- Leo Feraer-Oporto     

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