During a massage session, changes at both the structural and chemical level can lead to the surfacing of emotions in your client. Massage therapists must learn to manage these emotional releases in a way that supports the client and maintains the integrity of the therapeutic relationship.
Emotions can be described as the truth of the body-mind. They help people connect to what has meaning, what is really happening, what requires attention, and where letting go can occur. When emotional release happens in a massage session, it can be viewed as a natural process, where a healthy shift of the client’s body-mind leads to greater equilibrium.

Reasons for Emotional Release During Massage
Clients might experience a variety of emotions during or after a session.
Here are some examples of what might trigger an emotional release:

The Fullness of Life
Massage can evoke tender, open feelings not based on sadness, but rather on the recognition of the fullness of life. Massage allows a space for inner exploration, where people can reconnect with themselves and embrace their challenges and triumphs. As the therapist, you might see the client’s face soften and the eyes turn misty. Gentle tears may escape from the sides of the eyes and the client may take deep breaths.

Recognition of Disembodiment
Disembodiment refers to the sensation of being disconnected from the experiences of the body, or alienated from the body. Such feelings are often unconscious. A client can be shocked when the therapist points out a physical holding pattern, such as hunched shoulders, in a mirror. The client doesn’t view himself as hunched and fails to recognize the physical sensation of hunching.
Massage brings a person back into his body, and suddenly he is connected with his body’s sensations and needs. This can stir deep emotions. A sensation of grief might be felt as the client recognizes his previous disassociation from his body and experiences the sense of dismay this produces.

Remembering Repressed Memories
Researcher Candace Pert’s theory is that repressed emotions, and the memories that surround them, become stored in body tissue on a biochemical level. Massage manipulates the tissue where these memories may be biochemically stored, often allowing them to resurface into the client’s consciousness. In some situations, these memories can be frightening or traumatic for the client. Let the client know he is safe and that you can help him find the right people to further address these feelings if need be.

Freeing Emotion Held by Physical Tension
On a similar note, as the physical tension in a client’s body is reduced and softened during massage, emotions held in by tension patterns are freed. Often the client doesn’t have a specific memory that goes with the emotion, perhaps because different emotions have been building over time. It could be possible for the client to remain in the emotion, or travel through a variety of conflicting or related emotions without self-awareness of what is happening.

Laughing Fits and Euphoria
Some clients release pent-up tension with laughing fits or intense sensations of euphoria. The therapist might notice the client is smiling, then some giggles might escape, and then full-on laughing might erupt. The client might laugh so hard that the massage is disrupted and the therapist has to stop and wait for the laughing to subside. While these types of emotional releases might seem easier to deal with than anger, fear, or grief, they are just as complex.

Managing Emotional Releases
When emotional release occurs during a massage session, the therapist must manage two processes. First, he must manage his response to the client’s emotional expression while maintaining appropriate boundaries, and second, he must manage the process of ensuring that a safe, supportive atmosphere is maintained for the client.
While the factors related to the expression of emotion by clients may be complex, the actual process of managing emotional release is simple. Perhaps the toughest part is managing the personal emotions the client’s release may trigger in you.
Maybe you were raised in a family where showing emotion was discouraged. As a result, witnessing another person’s emotions frightens you or causes you to withdraw. Maybe the client’s tears remind you of your own sadness over a recent event. While these responses are normal, they may prevent you from holding good boundaries while providing appropriate support for the client.

Emotional Release Principles
Your goal as a therapist is to create an environment where the client feels safe, supported, and honored, and where emotional expression is viewed as normal and acceptable. These 10 principles support the emotional processes of clients in a way that is appropriate in a massage session.

Principle 1: Acknowledgement
Physical changes will alert you to a client’s emotional release. Watch for increased physical tension, changes in facial expression, breath holding or irregular breathing, misty eyes, tears, or overt signs of emotion like sobbing or prolonged laughter.
When you perceive an emotional release, acknowledge it and immediately communicate to the client that emotional expression is normal, productive, and acceptable. For example, you might say, “Mary, I can see you are experiencing some feelings around this work I am doing on your neck. It’s normal to have feelings emerge as tension is softened in muscles. By allowing your emotions to surface and move out of your body, you help to free tension on many different levels. Emotions are signs that we are making good progress.”

Principle 2: Presence, Responsiveness, and Contact  
During an emotional release, remain present and responsive to the client’s needs without losing physical contact with the client’s body. Depending on the intensity of the emotional release, you may need to stop the massage to allow the client to focus on her surfacing emotions. Explain to her what you are doing by saying something along the lines of, “Mary, I’m going to stop the massage for a moment so you can pay attention to what you are feeling. I’m right here with you.” Don’t remove your hands from the client as this could cause her to feel rejected or abandoned. Instead, place your hands in a holding position on a hand or foot, or lightly on the back, belly, shoulders, or under her neck. Don’t place a hand on her head, forehead, or stroke her hair as this can feel too parental.

Principle 3: Connect with Breath
Suggest the client take slow, deep breaths. If the client is trying to stifle sobbing, remind him it is OK and perfectly normal to cry. Encourage the release of the chest muscles so that breathing can normalize. You might say something like, “Bob, don’t feel like you have to hold back your feelings. It’s OK and normal to express emotion in massage. Try to take a deep breath and release your chest. That’s good. Keep breathing. I’m right here with you.”

Principle 4: Give the Client Time
The body processes and releases emotions naturally when it is given the time and space it needs. If the client is actively processing an emotion and you are maintaining contact, all you may need to say is “I’m here. You’re doing well.” In fact, if the client is moving forward in her emotional processing, you don’t want to interrupt her with too much verbalization. On the other hand, a client might try to rush her own process and say things like, “I’m OK and you don’t have to wait for me.” Let her know that this process is productive and may support the positive results she experiences with massage and to take the time she needs.

Principle 5: Allow Sharing or Privacy  
Affirm for the client that he can share with you what he is experiencing, or not, as he chooses. You might say, “Bob, it is often productive to talk about what you are feeling and if you sense that this would be helpful I am here to listen. If you don’t feel like you want to share this, that’s OK, too.” This is the perfect time to pull out those referral contacts if the client expresses a need to talk it through more in-depth.

Principle 6: Ground the Client
If emotions are allowed to flow freely without interruption, they will naturally dissipate and the client will most often enter a calm, open, and peaceful state. Ground the client by helping her return to the here and now, while honoring the event as productive and meaningful. You could explain: “Emotional release always happens when the body is ready, and you allowed yourself to go with it. I think this experience will mean a lot to your body going forward.”

Principle 7: Proceed or Refer
An emotional release may take as little as five minutes or take up the entire session. If the client enters a calm space, you can suggest the massage continues and then finish the session as you normally would. If the client feels he cannot proceed, respect his feelings and reschedule. It is appropriate to charge the client the fee for the session, but use your best judgment based on the situation.
In some cases, you may decide the session can’t proceed because the client’s reaction is outside the bounds of what can be contained by the therapeutic relationship (e.g., the client becomes violent and starts hitting walls—this is highly unlikely but possible). In such cases, or if the client expresses she is overwhelmed or frightened by what she is feeling or remembering, refer her to a counselor, other mental health professional, or to a therapist who specializes in somatic or body-mind-oriented bodywork.

Principle 8: Manage the End of the Session
If a client has experienced an emotional release during the session, the end of the session and the departure of the client from the clinic can feel uncomfortable if these moments are not managed effectively. This can be challenging when the emotional release happens late in the session. What will you do if Mary is crying on your massage table and David, your next client, is waiting in the reception area? It can feel very stressful because your tendency may be to take care of Mary and neglect David.
Remember that maintaining the boundaries of the session will help affirm for clients that their emotional release is normal and is not creating a problem for you. You might say, “Mary, our session time is over. I can see you are still feeling some emotions surface. You were able to free a great deal of tension during this session and so you may continue to have emotions surface in the coming hours. If you like, I can refer you to an excellent counselor in the area who can support this process. I feel like this was really positive and that we made excellent progress today. I’m going to leave the room now so you can get dressed, but I will come back in five minutes and process your payment here so you can have some privacy.”

Principle 9: Avoid Behaviors that are Damaging
When the client has an emotional release during a session, avoid making judgments or judgmental statements, problem solving, psychoanalyzing, inappropriate reassurance, and sympathy. These behaviors are damaging when they are used to manage an emotional release and they should be avoided. Refrain from advising clients or offering suggestions for next steps. Don’t analyze an emotional release or assume you know why it occurred.

Principle 10: Stay in Your Scope of Practice
If a client has an emotional release, you remain inside your scope of practice by offering support but refraining from offering your opinions, analysis, or advice. Counseling is outside your scope of practice and requires special training and a separate license. Even if you have credentials as a counselor or mental health-care specialist, you should not practice these skills within the boundaries of a massage session.

If your client has an emotional release during your session, support them, let them know it is a natural process that can occur with massage, and use the tools presented here to help you navigate these choppy waters.  

Anne Williams is the director of education for Associated Bodywork & Massage Professionals and author of Massage Mastery: from Student to Professional (Lippincott Williams & Wilkins, 2012), from which this article was adapted, and Spa Bodywork: A Guide for Massage Therapists, 2nd Edition (Lippincott Williams & Wilkins, 2013). She can be reached at anne@abmp.com.

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