Subversive Somatics: Massage with Clients with Developmental Disabilities

by PMTI alumn Sarah Hoops, LMT, of holding space together

Dear Community,

Since graduating from PMTI, a large part of my massage work has been with developmentally disabled clients. Even before enrolling at PMTI, I knew that I wanted to use the skills I learned to work with folks of varying identities whose bodies aren't typically affirmed - in fact, are judged, condemned, and violated - in dominant society. To do this work at the intersection of healing and justice has been my aim all along with my private practice.

Yet, even more than at my private practice, taking on clients with another, more specialized small business has allowed me to focus very specifically on adaptive massage with folks in group homes with widely varying developmental disabilities. Knowing how uniquely vulnerable folks with intellectual disabilities living in group homes can be to the strong hand of ableism - both systemic and individual - I was motivated to partake. I humbly approach the work as a path to try to subvert these oppressive ableist forces in whatever small way I can.

Working with a wide range of developmentally disabled clients has affirmed for me the power and effectiveness of kind, skillful touch as a means of connection

This massage work builds on my background of studying & engaging with Disability Studies & Disability Justice, my own experience as someone with psychiatric disabilities, as well as almost 10 years of work as a personal care attendant and caregiver in various settings (in and outside of group homes) with those across the disability spectrum.

Most of the massage clients I work with now are multiply disabled, and have physical as well as intellectual disabilities. Some also have psychiatric disabilities. My clients' levels of intellectual disability span a large range. Many don't speak or sign. Our communication is non-linguistic - but still quite effective and precise. Working with a wide range of developmentally disabled clients has affirmed for me the power and effectiveness of kind, skillful touch as a means of connection.

Furthermore, I've had the chance to explore my own assumptions about what massage "should" and "shouldn't" look like. With mindfulness of my own somatic experience as my guide, I continue to learn how to be a more creative therapist and a deeper listener of clients and their bodies.

I've been humbled by my clients' generous opening to me and my touch. I write this post to share some of my experiences around a few key themes that have exposed themselves as being valuable in my work with developmentally disabled clients. Thanks for letting me share!

being mindful of ableism - systemic and interpersonal - is key

I enter with an intentionally surfaced sense of humility

Perhaps what I've loved most about my experience is that I've not once been tempted to de-politicize the work. Working with clients who face ableism day in and day out - for most, compounded with other intersectional oppression - I am motivated to honor them to the best of my ability. I know this means staying vigilant and continuing to deepen my understanding of the politics of disability, access, bodies, touch, and healing/therapeutic work, in addition to deepening my professional massage skills. I aspire to conduct sessions that integrate an ever-deepening, holistic, meaningful, and intersectional understanding of Disability Justice - this is, in fact, the only way I can offer truly safe, healing spaces to my clients.

With regard to systemic ableism, since I'm working with clients who live in group homes, coming in with a background knowledge of how group homes work - well, often, don't work - has been vital to my practice of massage. It's been unbelievably helpful to be familiar with the world I'm walking into. I know that there is rampant neglect & abuse in group homes in this country. Neglect of group home residents is commonplace from governing bodies at all levels - from the lack of funds at federal and state levels, including layers of dysfunction in Medicaid, to the organizational politics at the group homes themselves, including ineffective boards and administrative decision-makers, down to the very management and mistreatment of the direct caregivers themselves.

There's a host of systems at play even when we look at the specific intersection of disability and massage. Has anyone else felt frustrated, for example, by the fact that the anatomical drawings in our massage books seem to always show able-bodied models? (Also, male, cis, thin, and white... why anatomical drawings need to have blue eyes is beyond me... but I digress...)

With awareness of systems of ableism in the back of my mind as I walk into the homes, I enter with an intentionally surfaced sense of humility. My effect will be small, but, hopefully, subversive. The clients I work with are survivors, and strong.

To do work that is not unintentionally harmful means not only interrogating the systems

Did you know? Stimming: usually NOT harmful, the repetitive movement of the body or voice, may express joy, anxiety, boredom, frustration, can be fun, relaxing, soothing, not necessarily an indication that a person unable/unwilling to attend to socialization, learning, etc., from

at play, but also my own oppressive tendencies. Practicing being mindful of my own internal somatic cues has been especially helpful. Of course in my intellect, I know it's silly to think there's a mere one or two or two thousand "good" ways to be in this world. "Good" and "bad," "better" and "worse" - these kind of judgments just don't apply when it comes to human beings and our bodies and ways of being! And yet, my body shows me signs of my own conditioned limitations in living into this belief wholeheartedly.

For example, recently I had to ask myself: Why do I feel a tenseness arise in my belly in response to one of B's particular stims? Why do I feel good when the massage helps her "relax into" not doing this kind of stimming so much? Is that really what's going on? Of course, I use feedback from her body language - including stimming or lack thereof - as a vital form of communication about her comfort and nervous system, especially since she doesn't communicate linguistically. Yet, I realized recently that I must intervene in my own presumptuous tendency to feel with B that a decrease in stimming is necessarily a "good" sign of relaxation. As I develop my capacity for self-awareness of my own discomfort, I can more easefully re-center B in our sessions, and not be sucked into, and then controlled so much by, my own reactionary responses.

While it's painful to witness my own internalized ableism, I try to keep returning to self-awareness as a path towards curbing my biases about "normalcy"

While it's painful to witness my own internalized ableism, I try to keep returning to self-awareness as a path towards curbing my biases about "normalcy." I most definitely need compassionate self-awareness to work to eradicate within myself any kind of judgment on the nature of clients' (and everyone's - including my own) bodies, minds, and ways of being. It's not personal, after all, that I've inherited a host of ableist tendencies from growing up in this society - but now, as an adult, it is my responsibility to interrogate my involvement. Being a massage therapist with developmentally disabled clients is yet another opportunity life has given me to move towards the freedom that comes with unlearning oppressive structures of thinking and feeling.

consent, affirmation & empowerment, and the politics of pleasure

Anyone familiar with the reality of group homes knows that consent around touch is often not practiced in everyday touch with folks with developmental disabilities, especially those with more severe disabilities, and/or those who don't speak or sign. In fact, touch is often used against residents, for control, manipulation, and convenience.

On my first night at one of the homes, when one of the residents became overwhelmed and started walking quickly around the home, flapping and agitated (but not harming himself or others), I watched a staff member try to "calm" him by aggressively grabbing his arm and trying to overpower him. In another home, a staff member with her arms full and talking on her cell phone sought the attention of B, the Deafblind and multiply disabled woman I mentioned above, by forcefully kicking the bottom of the recliner she was relaxing in and then, a bit less forcefully, B's leg.

And even if everyday experiences of touch aren't explicitly harmful, do they facilitate increased comfort and joy? Partnering with developmentally disabled folks to increase their access to joy, pleasure, and relaxation within their own bodies is radical. Bodily ease and pleasure is even more radical when we take into account the particular vulnerability to trauma that disabled folks live with, in an ableist society.

Massage, with its intimacy and dense interperso