I first encountered grief in my early 20s. Just a few months before I entered massage therapy school, my younger brother Chris was killed in a car accident. Then, a few years later, my mother died by suicide. After each of these losses, my body felt every bit as battered and broken as my heart, mind, and soul.
I’ve realized that the biggest surprise about grief is just how much it hurts physically. After a loss, the new normal often includes an aching body with sore shoulders, crippling headaches, and a painfully clenched jaw. Insomnia and appetite changes can lead to endless fatigue and irritability. Grief actually hurts.
We know enough about grief to dread the emotional, mental, and spiritual pain of a loss. It’s the physically painful aspect of grieving that can catch us off guard. How can it be fair to suffer on so many different levels simultaneously?

Combining Grief and Massage
Massage helped me. In fact, it helped me profoundly. I received weekly massage as a massage therapy student for the first 18 months after my brother’s death. By the time I graduated from massage school, I was intent on learning as much as I could about bodywork for grief. I wanted to specialize in this area because I had firsthand knowledge of how helpful massage could be. But, I was just a few years too early.
It was 2008, and the first research study on bereavement and massage therapy was still two years away. There weren’t many grief-oriented massage training resources available at the time. So, I harnessed my own personal experience and opened a tiny grassroots project in my city. I spent two years speaking to raise awareness and offering free and discounted massage for local individuals. I devoted much of my free time to the endeavor, which I called “Massage Helps.”
In 2009, my mother’s death uprooted my motivation to continue with Massage Helps. I took time off and started a regimen of weekly massages as I tried to cope. Like my first loss experience, the second experience confirmed that physically nourishing massage therapy can be a lifeline throughout the early stages of grief. My recovery was slow but the regular massage therapy seemed to help me continue moving through the process.
Then, in June 2010, a study was published in the Journal of Clinical Nursing by Berit S. Cronfalk that showed that massage was helpful for the recently bereaved family members of cancer patients.1 This was the first study to ever document the benefits of massage for grief. It was truly remarkable to read.
After that, a new nonprofit organization opened in my city: The Respite: A Centre for Grief and Hope. They wanted to provide holistic mind-body-spirit support for loss. I quickly partnered with staff at The Respite to create a larger massage program for grieving people. By this time, I was calling the modality “grief massage” and was gaining confidence that we were really on to something.
I firmly believed that grief massage should be available to those who couldn’t afford it. Loss can be devastatingly expensive and many grieving people suffer with financial hardship in addition to their physical, emotional, mental, and spiritual pain. So, in 2012, I decided to use my new partnership with The Respite to apply for a community service grant from the Massage Therapy Foundation (MTF).

Help for Survivors of Loss
The MTF listened to my story, and heard my insistence that grieving bodies need massage therapy. They provided my program at The Respite with a $5,000 grant—the maximum amount awarded to MTF community service projects. Over the course of one year, we were able to provide 39 people with a series of free grief massage sessions. I was also able to train an entire team of volunteer massage therapists in grief-sensitive massage therapy.
Our massage recipients were limited to those who had suffered a recent traumatic loss. We worked with suicide survivors, widows and widowers, bereaved parents, and even those who had suffered multiple traumatic losses. Then, in 2013, we applied for another community service grant, seeking to expand our focus to survivors of any type of loss.
The MTF again granted us $5,000. We began providing more grief massage sessions to an expanded recipient base, and I provided another training session in grief-sensitive massage therapy to a group of licensed massage therapists. Over the course of these two community service grant programs, the volunteer massage therapists and I have seen similar results and heard consistent feedback from our grieving massage clients. The overwhelming majority agrees: massage helps.
Massage therapist Jill Federal participated in both MTF-funded programs. Federal says grief massage calls to her because “loss is such a huge part of the human experience. We all experience it, whether it is tragic and sudden or what we consider the ‘natural course of things.’ I think, to be authentic, we need to embrace the experience of loss and grief just as surely as we do the joys and happiness that life brings us. To say to someone, through touch, that it is OK and safe to fully experience whatever it is you’re feeling in the moment—that’s a great gift.”
Massage therapist Janice Thompson also participated in both of the MTF-funded grief massage programs and says, “Our clients often had a palpable sense of sadness, despair, and hopelessness when they entered into our program. While grief massage doesn’t alleviate these symptoms, our clients generally left their sessions feeling more physically relaxed, less anxious, and less depressed. It is humbling that these clients were willing to allow us a glimpse into their pain and place their trust in us in their efforts to move through their grief processes.”
Thompson says her first experience working with a grieving massage client was eye opening. “Massage therapists routinely learn about the importance of forming boundaries with clients, and I felt reasonably skilled in this area. I was also well versed in the symptoms of grief based on my background and training, but coming into the situation as the professional was an entirely different experience,” she admits. “During my first grief massage, I found myself deeply affected by my client’s situation and continued to dwell on it after the session was completed.
“I ended up calling Aimee later that day, as I felt myself becoming sad and overwhelmed by my client’s story. As we talked through how I was feeling, Aimee assured me that I was experiencing a normal reaction as a grief massage trainee, and she was able to help me regain my perspective by reminding me I would not be able to help my clients if I was too enmeshed in their pain.”
The modality particularly hit home for massage therapist-turned-client Lila Sanacore, who experienced firsthand the nurturing and healing effects of grief massage. “After the tragic and sudden death of my brother, I came to The Respite. It was there that I found healing for my mind, body, and soul. I was lucky enough to begin learning grief massage with the goal of helping empower others to navigate through their own grief process.”

A Unique Offering
Massage is a unique way to help alleviate some of the physical discomfort associated with early bereavement. Massage therapy can serve as a simple cushion, providing respite and strength for the body amid the overwhelming emotional, mental, and spiritual pain of loss.
Grief-sensitive massage is not akin to counseling or trauma release. Rather, I see grief massage as the simplest of interventions—a humble comfort tool for the physical suffering caused by the extreme stress of early grief. Grieving massage clients can benefit from the most basic offerings: simple physical touch, a calming environment, and the restorative impact of gentle massage therapy on the nervous system.
When I train other massage therapists in grief massage, I emphasize the importance of staying within our scope of practice. It is essential for us to restrict our focus to stress relief and physical comfort for grieving clients. It is never appropriate to give counsel or advice on grief because that is far beyond our scope of practice. I urge massage therapists to instead focus on the value of what we can offer—an accepting atmosphere of comfort and physical support—while making appropriate referrals when necessary.
We know that grief is highly stressful. In his book Managing Stress: Principles and Strategies for Health and Well-Being, Brian Luke Seaward highlights the Social Readjustment Rating Scale.2 This scale (right) was developed many decades ago by researchers to rank 43 life experiences by the stress levels associated with them. Death of a spouse is ranked as the most stressful of all life events and the death of a close family member is ranked as number five. It is thought that the amount of readjustment these losses require can be linked to why they are so stressful. It is very hard to adjust to a “new normal,” especially when that new normal is extremely painful.
 As massage therapists, we are well educated in the detrimental effects of stress. We also know, on a deep level, that massage therapy can play an important role in treating the effects of stress on the body. I encourage grief-sensitive massage therapists to focus a great deal of attention on the sympathetic and parasympathetic branches of the nervous system. We need to develop a renewed appreciation of massage therapy’s potential role in shifting the body from the fight-or-flight response to a relaxed, restorative state.
In my experience, the most basic, simple, and uncomplicated aspects of massage therapy seem to be the elements that are most helpful in a grief massage setting.

The Future of Grief Massage
The Respite closed in 2015, but the pioneering vision for providing grief massage in Charlotte, North Carolina, and beyond is alive and well. Participating in the MTF-funded grief massage programs at The Respite was a deeply impactful experience that many of the massage therapists who participated have carried forward in their own unique ways.
Federal says that more than four years after her initial participation in the grief massage program at The Respite, her experience has deepened her approach in a variety of massage settings—even when a client has not specifically requested grief massage. “Having been trained in grief massage, I find myself calling on that information often. Sometimes it’s simply to remind myself about the soothing properties of intentional touch; other times, I use the information in a more specific manner,” she says. “Understanding some of the typical challenges people undergo during the grief process allows me to get right to work in easing some of those difficulties.”    
The work can be applicable to other modalities as well. Thompson says her experiences working in the grief massage program at The Respite have empowered her work. “Becoming a certified grief massage therapist helped me become a better overall therapist. I am more open to the emotional states of my clients and am able to incorporate aspects of grief massage into my massage practice,” she says.
I, too, continue to work toward spreading awareness of the benefits of massage for grieving clients, because I can imagine a future where grief-sensitive massage therapy is a standard early intervention for the bereaved. I imagine grief massage centers set up in major hospitals, offering care to the family members of patients who are dying or who have died. I want to see nonprofit grief massage centers created in every city across the globe, potentially offering free massage therapy sessions to all community members who are experiencing the pain of loss. I envision a network of private massage practices either solely dedicated to grief massage or providing grief massage among a variety of offerings. I want grief massage to be readily available, through independent massage therapists as well as larger organizations, whenever a grieving person is in need of physical relaxation and support.
From my perspective, all these options are entirely possible. We simply need to raise awareness of the role massage therapy can play in early bereavement. We need more research. We will need more funding from organizations like the Massage Therapy Foundation. And, since we will need more compassionate massage therapists who are willing to do this work, we need excellent grief massage training courses and resources. Training other massage therapists and sharing my own experiences has become my passion.

Honoring the Human Experience
Working with many massage therapists from across the United States, I have found there is a deep calling to serve bereaved clients. Massage therapists can create an important body-oriented shift in the way our society approaches care for the grieving. We can make a real difference. Consider learning more about grief and massage. Seek out other experienced teachers such as Lyn Prashant (www.degriefing.com) or Mary Kathleen Rose (www.comforttouch.com). Listen to my “Grief Massage Conversations” podcast, learn about the physical effects of grief, develop confidence in the benefits of massage, train to add grief massage to your own practice, or start volunteering in your community.
Grief is part of the human experience—something we will all eventually work through. Learning to create space and comfort for grief is part of creating cultural change. By offering massage therapy as simple physical comfort for grief, we can honor the experience of loss, honor those we have lost, and find solidarity in our common humanity.

A Guide to Grief-Sensitive Massage
1 Focus on the First Year. In my experience, physical discomfort seems to be most intense in the early stages of mourning. The first weeks and months following a loss seem to be an important time for offering a grief-sensitive massage intervention. Early bereavement was the focus of Berit S. Cronfalk’s research, and I have seen a profound benefit when working with early bereavement, too. Benefits are likely to be seen throughout the first two years, but in my experience, the earlier interventions seem to offer the most benefit.

2 Know You’re Providing a Worthwhile Service. Many grieving people want massage. Long before reaching out for counseling or other traditional means of grief support, I have seen bereaved people seek out massage therapy. In my experience, many grieving people are open to massage because they need relief from their extreme stress and physical discomfort. At The Respite, our massage program was far more popular than any other grief-support offering.

3 Stick with Your Scope of Practice. Because massage is often the first support tool sought out by grieving clients, we must be extremely diligent about restricting our focus to only body-oriented stress relief. Grieving clients can be very vulnerable and are often in need of additional support. Be extremely cautious and mindful of your scope of practice, and be prepared to make referrals for counseling and other forms of grief support.

4 Remember a gentle touch is key. In my experience, many grieving clients display increased sensitivity to pressure. Even when requested, a firm or deep massage can be overwhelming. Many grieving clients seem especially prone to next-day soreness, and there also seems to be an increased potential for emotional release. Err on the side of caution and use extremely light pressure. Note: Cronfalk’s study used gentle to firm Swedish-style massage for the hands and feet, while my program primarily utilizes full-body, light, Swedish-style massage (skipping upper legs and gluteal regions).

The Grief Massage Sequence
My grief massage protocol, what I call Safe and Gentle Grief Massage, looks much like a Swedish-style session, and features slow pacing and gentle pressure. Techniques such as sweeping effleurage, static hand holds (allowing “soft hands” to rest on the client for 5–10 seconds), and nerve strokes are especially helpful for areas such as the arms and back, while petrissage is utilized on the calves; very soft “squeezing” works well for the feet.

During intake, clients are invited to tune in to which area of their body is holding the most stress or tension, and that area then receives gentle therapeutic focus. Common areas of tension or stress for grieving clients are the neck and shoulders, jaw, and lower back.
 
To create a sense of safety and comfort for vulnerable clients, I avoid treatment areas that can be sensitive, such as the gluteal muscles, upper legs (quadriceps and hamstrings), and pectoral muscles. Throughout my grief massage sessions, I focus on wholly immersing the client in a cocoon experience of safe and gentle touch.

While developing my protocol over the years, I noticed I was learning to give grief massage at a slower and slower pace. I was also refining my ability to provide a varied spectrum of gentle pressure. My grieving clients seem to benefit most from my slowest, gentlest work.

A Mother’s Grief—Practitioner and Client
Massage therapist Shannon Brooks participated in the first Massage Therapy Foundation-funded program at The Respite, and she learned firsthand how beneficial the work can be.

“After the loss of my daughter Skylar in 2010, I was devastated and grieving all the moments I would never get to experience with my baby girl,” Brooks said. “Getting a massage was not a priority for me, as I attempted to deal with all the heavy emotions that were dragging me deeper. Luckily, I had friends who were massage therapists, and they convinced me of the importance of getting manual work to help me feel better and begin my healing.

“When I was in a deep state of grief, my whole body hurt. I couldn’t focus or even try to process my emotions because I was physically hurting. A massage would transform my day. It didn’t take away my grief or stop my tears, but it did help me deal with my loss because I was able to relax, release tension, and acknowledge my emotions without being distracted by my aching body.

“At The Respite, there were no expectations. People felt safe to relax even if it was just for an hour. It was truly an honor to give a grief massage to someone who had lost a loved one and to walk beside them on their own journey of grief and hope. For me, I believe that my grief journey will be lifelong, but I also believe that through helping others I am healing and transforming my life. I am so grateful for the opportunity to have been a part of such an amazing organization that made such a difference in so many lives.”

Notes
1. Berit S. Cronfalk, Britt-Marie Ternestedt, and Peter Strang, “Soft Tissue Massage: Early Intervention for Relatives whose Family Members Died in Palliative Care,” Journal of Clinical Nursing 19, no. 7–8 (April 2010): 1040–8.
2. Brian Luke Seaward, “Managing Stress: Principles and Strategies for Health and Well-Being,” 8th ed. (Sudbury, Massachusetts: Jones & Bartlett Learning, 2014).

Aimee Joy Taylor has been a licensed massage therapist since 2007 and is the creator of the grief massage modality. Taylor offers NCBTMB-approved courses on grief massage. For more information, visit www.griefmassage.org.