Now, let me state unequivocally that as massage therapists we do not do psychotherapy! Depression has major physiological and anatomical components. It is with these components that massage can truly have a significant and profound effect. As massage therapists we will not work with the verbal processing of clients’ problems. Instead we will be working with their body that has specific symptoms due to depression.

To be effective working with a depressed client’s body we need to understand depression and how it manifests physically. We also need to understand different types of depression and how physically they respond differently to massage for support.

Situational depression: When looking at depression, we are going to find clients who are situationally depressed. They usually have situations in life that are stressful and appear overwhelming. Before these situations arose they had very few days that they could actually say they felt depressed. Situational depression often arises in the mourning process where there is loss. Mourning the loss of a significant person in someone’s life like a child, is easily understood and identified. There is also mourning that is sometimes called disenfranchised grief where the clients do not feel they have a right to feel so strongly and mourn the loss. This can be as easy to understand as the loss of a pet or a friend who they had not seen or even thought about for some time, or as nebulous as the loss of health, or functions such as driving in the elderly. While it does not fit our normal picture of when or how we should grieve, there is still significant loss and oftentimes, because we do not allow ourselves to fully experience the feelings, it is even harder to understand and let go.

Family of Origin depression: There are other forms of depression that are more psychological in nature and usually stem from family of origin issues that have been unresolved. Often these clients will have been in therapy to work on these issues and many will be medicated for depression. There are many instances when a significant event will stimulate the onset of depression from early family of origin issues. Because family of origin depression is often stimulated and intensified by an event in the present, it will often be accompanied by additional physical symptoms and not respond as well to treatment as situational depression. Even after the event has passed these clients are often left in low grade chronic depression until the next event brings on another acute episode of depressions. Because the seeds of depression have been around since early childhood in family of origin depression, there has been plenty of time for the body to grow into a depressed and collapsing structure that gets significantly worse when the issues arise. There are also biochemical changes in the endorphins.

Moderate depression, like family of origin depression, will be longer term than situational depression. However, unlike family of origin depression, moderate depression will often be triggered with no discernable event. It often times appears cyclic even to the time of the year. These clients are often on long term medication and in therapy. There is often the risk that the client with moderate depression will slip into severe depression with suicidal tendencies. Because of the longevity and severity of moderate depression there are substantial structural and biochemical changes to the endorphins. It is important that the client with moderate depression be monitored by mental health professionals during their duration of massage therapy.

Severe depression often requires hospitalization and major medication. These clients usually won’t be coming for massage until they have had months of therapy, both psychological and chemical. Due to the severity of the depression their issues are often profound, and the changes both structurally and biochemically to the endorphin system are more severe. When these clients come for massage, it is important for the massage therapist to be working with the psychiatrist and/or psychotherapist to monitor the risk for the clients’ relapse and potential suicide. As significant as the problems are for the severely depressed there is still a lot to gain with properly applied massage therapy.

Chronic depression is usually moderate to sever. These clients are being treated by mental health professionals with both medication and therapy. Because of the duration of chronic depression there will be significant structural collapse and changes in the endorphins. While receiving massage therapy they should also be monitored by a mental health professional.

Seasonal Affective Disorder (SAD) is often treated like depression since the symptoms are similar. The good news is that being in Florida we have sunlight approximately 360 days a year which takes away the trigger of lack of sunlight for SAD. However, in the winter we have a huge influx of clients from the north who may be suffering from SAD when they first arrive. The severity of depression is usually similar to that of situational depression. They usually improve as their exposure to sunlight increases.

Having looked at the different types of depression we can start to identify some of the physiological and energetic challenges for those who are depressed. This is where massage therapy can accomplish physical changes that normal psychotherapy or medication cannot.

With all the above forms of depression there is a structural collapse in the client. This structural collapse includes a shortening of the abdominal muscles and a tightening of the diaphragmatic arch which pulls the chest down and forward limiting its ability to expand during breathing. There is an additional medial rotation of the shoulders and internal rotation of the arms resulting in a kyphosis that further restricts breathing. Without the support of the thoracic region, the head and neck will move forward and down and further into collapse. All this distortion of the upper body will lead to further distortion in the lower body and give the structure an image of being fully collapsed. The degree of structural collapse will depend upon the severity of depression and its duration.

There are several more components that are involved in the structural collapse which are described in detail by Alexander Lowen and other bioenergetic therapists/authors. The first is the muscles of the breathing process will become chronically tightened and limit the ability to breathe and energize the structure. Consequently, most depressed people are short of physical energy and have a difficult time energizing their bodies to move forward out of depression. Another factor is that these chronically tightened muscles of the breath process also restrict expression of emotion. Unexpressed emotions in the body are trapped energy and it takes increased energy to continue to suppress and trap them. For depressed clients this further depletes their energy. When this happens, character armor forms, which is chronically tightened connective tissue. It is nearly impossible for clients to shift out of this depression unless this tightened tissue is effectively released with massage therapy.

Let’s look at how properly applied massage therapy helps with depression. First, if massage therapy is applied to release the structural collapse associated with depression, it will bring the client from a hopeless, helpless collapsed structure to one that is supported and erect. The sense of support from the client’s structure will give the client feelings of being stronger and more capable of dealing with the issues of their depression. Key areas to release for structural support that are also part of the character armor are: 1) the abdomen and diaphragmatic arch, 2) the musculature and connective tissue of the front of the chest that cause a sunken chest and medial rotation of the shoulders, 3) the musculature and connective tissue of the anterior shoulder and upper arms that cause an internal rotation of the arms, 4) the musculature and connective tissue of the anterior neck followed by the posterior neck and top of the shoulders. Follow this by bringing the legs out of hyperextension and more under the body. All of this will result in a significant structural change in a depressed client.

While releasing the structural collapse associated with depression you will also be releasing the breath process which will allow depressed clients to energize their system and have more energy. This additional energy will allow them to take part in their lives and move out of depression. In addition, the additional energy that will be mobilized by the release of the breath process will allow the release of further trapped emotional energy from behind the character armor. Much of this trapped emotional energy will be from situations, family of origin, or accumulated over time, and its release will help free the client from past depressed behavior. There will also be a lessening of pain and an increase in positive endorphins.

Since much of the tightened soft tissue related to the structural collapse and the character armor will be full of sensation, the 3-step approach (in the 2001 Nov/Dec issue and on our website) will be extremely effective and stay within the client’s tolerance to sensation.

As you can see, the educated massage therapist can have a significant positive effect on depressed clients by addressing their physical symptoms. Please work as a team with other mental health professionals.

Publications                Contact Us