How to Hold Space for Trauma Without Feeling Like You're Playing Therapist

What do you do when a patient starts opening up about something heavy — and you're not sure if it's your place to respond?

Most massage therapists either freeze, change the subject, or redirect to something clinical. And while that feels safe, it sends a message the patient notices more than you think.

In this episode, Jamie breaks down what trauma-informed care actually looks like in practice — not theory, not counseling — just how you show up in the room.

You'll learn:

• Why almost every patient you see has experienced trauma by definition
• Why changing the subject when someone opens up is never neutral
• Hobfoll's Five Elements of Trauma Intervention — a framework built for mass trauma that applies directly to your treatment room
• What safety, calm, self-efficacy, connectedness, and hope look like in practice
• Why your therapeutic relationship is already one of the most powerful healing tools you have

This isn't about overstepping your scope. It's about recognizing what's already in it.

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Connect with Jamie:

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🌐 Website: www.themtdc.com

If The New Generation Massage Therapist Podcast has shifted how you think about your practice, the best thing you can do is hit follow and leave a review — it takes two minutes and it helps other therapists find this content. That's the whole point. Thank you for being here. 🎙️

Transcript

00:00 - I want to tell you about a call I'll never forget. A woman on a motorcycle had rear-ended a Nissan Pathfinder. When I walked up, my Chief had already taken C-spine with her, but she looked up at me and said, "I can't feel my legs."

00:23 - It took everything I had to keep my composure. I got down on the ground next to her, I took her hand, and I said, "We're not going to worry too much about that right now, because the doctors are going to help you with that once you get into the hospital. Let's just make sure we get you there safely." And then we packaged her up, got her into the ambulance, sent off to the hospital.

00:46 - Now, I want to tell you why I said what I said, because I almost didn't. You see, my very first first-aid instructor, the first one I ever had, told me something that I've never forgotten. He said, "Never look at a patient and tell them everything is going to be all right, because you don't know if it will be. Don't lie to them. Give them what's true, and what's useful."

01:14 - So in that moment, on the ground next to this woman, that voice came back to me. I couldn't promise her she'd walk again, but I could tell her the truth: that we were going to help her get to people who could help, and I could hold her hand while we did it. I wasn't her doctor, I wasn't her therapist, and I certainly wasn't her neurologist. But I was fully present, and in that moment, that was exactly what she needed. That's what holding space looks like, and it's what I want to talk to you about today.

01:45 - (Intro Music) Hey there, I'm Jamie Johnston, and you're stepping into a new era of thriving as a massage therapist. We're embracing who you are, pursuing what you love, and confidently shaping your practice. We'll challenge industry norms, spark change, and discuss what truly matters—things like mental health, evidence-based practice, and some topics we've long avoided. Let's create better outcomes for our patients, and happier, more fulfilling practices together. Welcome to The New Generation Massage Therapist Podcast. 

02:18 - I want to start with something that I think is going to shift how you see every single person who walks through your door. The word "trauma" has two dictionary definitions. The first one you probably know: a deeply distressing or disturbing experience. But the second one: physical injury.

02:40 - Think about that for a second. By that definition, almost every person who comes to see you has experienced trauma. And in a lot of cases, that's exactly why they're there. Now, I know some of you are probably thinking, "Jamie, my patients aren't trauma patients. They've got a sore neck, they got a tight lower back, or, you know, they just pulled something at the gym." Maybe.

03:07 - But let me ask you this: What about the person who's been in persistent pain for 3 years? Who has seen doctor after doctor, and every single appointment, they leave feeling like nobody actually listened to them? The one who walks into your treatment room already bracing themselves to be dismissed again?

03:28 - Now, to go with that, I want to share something that recently just stopped me in my tracks. An old friend of mine, somebody that I went to school with right from elementary school through high school, reached out to me after one of my posts. You see, she was hit by a truck when we were teenagers, and what she shared has stuck with me ever since she reached out.

03:52 - She wrote to me and said, "I fear them listening, but not hearing. Being heard and understood is important during a visit. Being vulnerable needs to have safety. For me, I feel safe when I am heard, not just listened to. I have not felt heard by almost every doctor I've been to. What happened to me? I was a pedestrian run over by a truck. No more questions asked. Trauma. Told to see mental health, seen for 3 years, yet the pain isn't changing. My anxiety isn't from my injury; it's from walking into a doctor's office wondering if they will finally hear me."

04:41 - Think about that last line again. Her anxiety isn't from the injury; it's from the system that's supposed to help her. She wasn't at a mental health crisis point, she wasn't asking anyone to be her therapist—she just needed someone to make her feel like a human being in the room. And that person? That person could be you.

05:07 - And here's the thing: when you start to see your patients through that lens, acknowledging what they're going through isn't playing therapist. It's recognizing reality. It's being human. The trauma doesn't have to be dramatic. It doesn't have to be a motorcycle accident or a house fire. It can be the slow accumulation of pain, of feeling dismissed, of being told the scans look fine when you know something is wrong. That's distressing, that's disturbing, and that meets the definition. And when that person walks into your treatment room, they've often been carrying that weight alone for a long time.

05:52 - Trauma-informed care is one of the biggest buzzwords in our industry right now, and it should be. But here's what I keep hearing when I talk to other massage therapists about it: "That's not my scope." "I don't know what to say when someone starts opening up." "I just change the subject. I don't want to go somewhere I'm not trained to go."

06:14 - And I get it. I genuinely do. None of us want to overstep. None of us went to school to be a therapist, and the last thing any good massage therapist wants is to make a patient feel worse by saying the wrong thing. But here's what actually happens when you change the subject, when you redirect, when you shut it down because you're not sure what to do: that patient notices.

06:40 - They came in already carrying something. They started to open up, which, if you understand anything about trauma, you know takes courage. And then the person they trusted closed the door on them. That's not neutral; that has an impact. Now, I'm not saying you need to sit and process trauma with them. I'm not saying you need to ask them to walk you through what happened. That's not your job.

07:05 - But here's what trauma-informed care really actually means in practice. And it's not about what you treat; it's about how you show up in the room. You don't need a psychology degree to make someone feel safe. You don't need a counseling certification to validate what somebody's going through. You don't need anything other than what you already have: awareness, intention, and the right framework.

07:33 - And that framework? Well, you're already closer to it than what you think. A few years ago, I became a Psychological First Aid instructor, and as I was going through the course, I kept stopping and thinking, "This is how we should approach every single treatment that we do."

07:56 - The framework is called Hobfoll's Five Elements of Trauma Intervention. It was originally developed for mass trauma response—the kind of situations I have spent my career training for as a firefighter: earthquakes, house fires, mass violence—basically the worst days of people's lives. But here's what struck me: the five elements that help people recover from mass trauma are the same five things that help your patients recover from whatever brought them to your table.

08:29 - So let me walk you through them. And as I do, I want you to think about what this already looks like in your practice.

08:41 - Element 1, the first element: Promote a sense of safety. After a traumatic experience, a person's world gets disrupted. Fear starts to show up in ways that can look irrational from the outside, but make complete sense when you understand what they've been through. The person injured at work is terrified to go back. The person in a car accident is scared to drive. The person who's been in chronic pain is bracing for their body to let them down again.

09:05 - So, what does safety look like in your treatment room? Remember my friend that I mentioned earlier, the one who was hit by a truck as a teenager? She said something that we should keep coming back to: "Being vulnerable needs to have safety. For me, I feel safe when I am heard, not just listened to."

09:30 - That's it. That's the whole thing. It looks like patient-centered care. It looks like shared decision-making—actually collaborating with your patient on what you're doing and why, instead of just doing things to them. It looks like giving them a voice in their own treatment. When a patient feels like they're part of the process, not just a body on the table, their nervous system starts to settle.

09:59 - And research shows that promoting a sense of safety is essential for reducing post-trauma reactions. And the beauty of it is, you don't need a new certification to do it. You need to slow down, explain what you're doing, ask them what feels right, and actually listen when they answer. That's it. That's safety.

10:24 - Then there's Element 2, which is the promotion of calm. One of the most damaging things that happens to people in persistent pain is the story they start to tell themselves about it. They start talking to themselves and thinking: "I must be weak," or "There's something seriously wrong with me," or "My body is broken."

10:44 - That narrative doesn't just affect their mental state; it increases anxiety, which increases pain perception, which makes everything harder, and it becomes a cycle. As massage therapists, one of the most powerful things we can do is change the language around what's happening in their body. Moving away from tissue damage explanations, stepping back from language that makes people feel broken or fragile. Helping them understand that their body is not their enemy; it's responding to something, and that response can change.

11:18 - When you shift from "your tissue is damaged" to "your system is sensitized, and here's what we can do with that," you're promoting calm. When you normalize what they're experiencing—you know, like "A lot of people dealing with what you're dealing with feel exactly the same way"—you're promoting calm.

11:39 - And yes, I'll state the obvious here: a great massage promotes calm. Breathing, movement, grounding. But here's where it gets interesting: most massage therapists are using these tools without really understanding why they work beyond the physical level. When you understand the connection between calming the nervous system and your patient's pain and trauma response, the way you use those tools completely changes.

12:12 - Element 3: The promotion of self-efficacy. Now, self-efficacy is the belief that your own actions can lead to positive outcomes. And when it comes to trauma and pain, it's about helping a person feel like they have some agency over what happens to them—that they're not just a passenger in their own recovery.

12:30 - Here's where a lot of treatment models fall short. When we only ever give people passive treatment—they come in, lie on the table, receive treatment, go home—we can accidentally reinforce the idea that the only thing that helps is us. That without the appointment, nothing gets better. And that's the opposite of self-efficacy.

12:54 - So, what does promoting self-efficacy look like? It looks like making sure movement is part of the conversation. Home care that actually empowers them. Teaching them something about their body that makes them feel more capable, not more dependent.

13:11 - And the research shows there are two things that are necessary for self-efficacy to develop: the person needs to feel like they have the skills to manage the problem, and they need access to resources that support them in doing that. Guess who can provide both of those things for them?

13:34 - Element 4: The promotion of connectedness. Social support plays a massive role in recovering from trauma. Friends, family, community—all of it contributes to problem-solving, emotional processing, and resilience. And we play a role in that too.

13:50 - Now, I want to be clear about something here because I think this gets misunderstood. This doesn't mean pushing for more frequent appointments. It doesn't mean making your patients feel like they need to see you constantly to stay okay. It means the quality of every interaction you have with them matters. Your therapeutic relationship is a form of social support.

14:14 - When someone comes to see you and they leave feeling genuinely understood—not just treated—that contributes to their recovery in a way that goes way beyond what your hands did. Work on that therapeutic relationship every single time—not by adding more sessions, but by making each one count.

14:40 - Element 5, and this is the final one: Instilling hope. How many of you have seen The Shawshank Redemption? Put your hand up. (I can't see your hands, anyways.) It's one of my favorite movies. There are two characters in that film with completely opposite views on hope. If you've seen it, you'll remember that Andy says: "Remember, Red, hope is a good thing, maybe the best of things, and no good thing ever dies." But Red, at least early on, pushes back hard and he says: "Hope is a dangerous thing. Hope can drive a man insane."

15:15 - I think about those two characters a lot when I think about the patients who walk through our doors. Some of them are Andy: they come in with hope still intact—maybe bruised, maybe fragile, but it's still there. They believe that things can get better. And some of them are Red: hope has been beaten out of them by years of pain, by appointments where nobody listened, by being told the scans look fine when they know something's wrong, by a system that kept listening without ever actually hearing.

15:52 - And here's the thing: the research backs this up. Hope is defined as a positive, action-oriented expectation that a positive future goal or outcome is possible. And people with a hopeful outlook genuinely have better outcomes—full stop. There's a model called the Learned Optimism and Positive Psychology model that shows us that strength-based, prevention-focused interventions actually increase hope and interrupt catastrophic thinking.

16:26 - So, what does that mean in your treatment room? Well, it means validation matters. When a patient tells you how hard this has been and you reflect that back, saying things like, "What you're going through is real, and I hear you," you're not just being kind—you're doing something clinically significant. It means highlighting their strengths. When a patient walks in defeated and you can point to something they did well—"Look how much your range of motion has changed since we started"—you're building hope.

17:02 - And at the end of The Shawshank Redemption, Red finally gets there. He says, "I hope I can make it across the border. I hope." And he does. With a little help from Andy—someone who never stopped believing in him even when he'd stopped believing in himself—Red makes it. They meet on the beach. All the years of struggle, all the false starts, all the moments where hope felt like the most dangerous thing in the world—it paid off.

17:34 - That's your job: not to fix everything, not to be their therapist, but to be the person—maybe one of the only people in their entire healthcare journey—who never stops believing that things can get better. Who helps them get back to hope one session at a time. You can do that without a therapy degree, without overstepping your scope. It's already yours.

18:03 - So let's bring this all back together. Holding space for trauma doesn't mean you become someone's mental therapist. It doesn't mean you sit down before the treatment and ask them to walk you through what happened. It doesn't mean you have all the answers. It just means you show up differently.

18:24 - It means when someone starts to open up, you let them. You don't change the subject. You don't redirect to something clinical because you're uncomfortable. You let them finish, you acknowledge what they said, and you validate it—saying things like, "That sounds really hard," or "That makes a lot of sense given what you've been through," or something as simple as, "I'm glad you told me that." That's it. That's holding space.

18:54 - And then, if it's outside what you can help with, you be a resource. You know who else is on this person's team, and you know when to refer. You know how to say, "What you're describing sounds like something that would really benefit from support beyond what I can offer. Have you thought about talking to someone?" That's not overstepping; that's collaboration. That's being part of a healthcare team.

19:21 - The research is clear: social support, the quality of your therapeutic relationship, and strength-building interventions all reduce post-trauma reactions. And you are uniquely positioned to provide all three of those things. And you're already doing some of it; you just haven't had the language or the frameworks to know what it's called. And well, now you do.

19:48 - So, that's how you hold space for trauma without feeling like you're playing mental health therapist: you recognize that almost everyone who walks through your door has experienced trauma by definition. You understand that trauma-informed care isn't about what you treat; it's about how you show up. And you use a framework—Hobfoll's Five—that was built for the most extreme moments of human suffering and applies just as powerfully to the people sitting across from you every single day.

20:18 - So remember: safety, calm, self-efficacy, connectedness, and hope. You're already doing pieces of this, and this series is about doing all of it intentionally.

20:33 - In the next episode, we're going to go deep on the first element: safety. Because I want to talk about something that took me a long time to understand: that the most important thing you bring into a treatment room sometimes isn't your hands at all. It's whether or not the person on your table feels safe enough to actually let you help them. That one's called "Promotion of Safety is the First Job, Not Your Hands," and I think it's going to change how you think about every treatment you do.

21:05 - If this episode resonated with you, if something here shifted the way you're thinking about the people you see, I'd genuinely love to hear about it. Find me on Instagram, send me a message, because these conversations are worth having. And if you're getting value from The New Generation Massage Therapist Podcast, the best thing you can do right now is hit follow and leave a review if you have two minutes. It genuinely helps more therapists find this content, and that's the whole point.

21:32 - Keep moving forward.