The Real Massage
Ana Bott, the first clinical massage therapist to specialise in LGBTQ+ patients, talks working on trans bodies and taking a trauma informed approach to massage.
“After working for a decade in child protection doing work which is often very graphic and traumatic, I wanted someone to take care of my body in a nurturing way,” Ana Bott says. “But when I tried to access massage therapy it felt so clinical, and it didn’t reflect the training I’d had in working with people with trauma.”
As a queer person with autism, Bott felt like her experiences with her body and identity weren’t catered for in traditional massage therapy, so she decided to study it herself. “It was a bit like needing a medicine that doesn’t exist and just inventing it,” she says. During her training she completed her case studies on trans clients, and by the time she graduated she already had a waiting list.
Bott became the world’s first clinical massage therapist to specialise in LGBTQ+ patients, and co-wrote a qualification in LGBTQ+ inclusive healthcare which includes everything from spotting chronic conditions to understanding post-surgery trans anatomy. She also won Inclusive Business of the Year 2021 thanks to her trans specialism, low income and charity subsidised appointments, hydraulic massage tables, size inclusive linens, and fidget toys for neurodiverse clients. “I even have a special cushion which has space for silicone breast implants so my transfeminine clients can lie on their front without feeling uncomfortable,” she says.
Alongside her advanced clinical massage training she uses a patchwork of influences from kink to tantra, incorporating active consent, breath work, meditation and aftercare into her work. “Often I’ll have a tissue in one hand to dab people’s tears away, but there’s a lot of joking around in my treatments too,” she says. “It’s just about making space for people to be themselves.” Read on to learn more about Bott’s groundbreaking work.
What was your massage training like?
The syllabus for massage therapy doesn't reflect how mental health and trauma affects the body, and it’s also based on cisgender, white, able bodied people. It doesn’t teach how to work with trans bodies, or people in a wheelchair, or people with a weave or braids that can get really messed up by a scalp massage. I did the advanced clinical massage qualification so that I could write letters to people’s doctors explaining what’s going on in their bodies and be taken seriously. In the UK, the main contributing factor to low health outcomes for trans people is a lack of clinical awareness. Care staff haven’t been trained in working with someone with phalloplasty, for example, so their doctors don’t spot complications. Conditions like fibromyalgia or hypermobility are also more common in LGBTQ+ people, and when I’m able to help people get a diagnosis they can then apply for disability living allowance.
How do you use energy in your work?
I trained with Michael Gibbons who is heavily involved in massage therapy and healing at Glastonbury music festival. He has a very big focus on energy and slowing down and matching your breathing to the client’s and feeling the vibe of their body. Sometimes I’ll put my hand on an injury and it’s like I know what happened. Is that something spiritual, or is that me as a person with trauma using my own hyper vigilance to read a situation? I’m not sure. But there's a technique called palpation, where I rest my hand on the body and every time they exhale, I allow my hand to sink deeper into the tissue. You can drop so deep, yet so softly, inside someone's body using that technique. When it's so gentle and the body isn't resisting, you can feel everything. You can feel blood moving around, you can see the bone, you can feel the fibres of the muscle.
How does your work in child protection inform your massage practice?
Although there was no physical touching in my previous work, part of it was getting people to listen to their bodies again and recognise signals of danger. Something I found working with young people with sexual trauma is that they often had a bad gut feeling in their body when they saw the person who would go on to hurt them. We live in a society where bad gut feelings are dismissed all the time — but actually, when we feel a bit sick or dizzy or have a weird taste in our mouth, that’s our nervous system telling us that something is not right.
Do you notice specific pain patterns in clients with sexual trauma?
Trauma manifests in the same way in the body, whether it’s sexual trauma or a near death experience. Whilst there will always be unique triggers, specific to that individual, there are key muscles in the respiratory system, shoulders, neck, jaw and back which all tense up as part of our body’s fight or flight system.
How do you ensure active consent throughout a session?
For me there’s three parts to active consent. First, there’s discussing what someone is comfortable and uncomfortable with in the consultation before I even touch them. So they might tell me they have some touch-based trauma around their neck, but they still want me to work in that area. But I’m aware that what someone consents to when we’re both fully clothed and in a neutral playing field might feel different when they’re naked and face down on the bed. So the second part is checking in again on that consent when I’m about to move onto the neck. Sometimes people think that asking for consent during treatments must be clunky, but it's not, it makes people feel safe and empowered, and it’s part of holding their nervous systems. One of the things that happens with trauma is the brain is constantly guessing what's going to happen, so if they know what part of the body I’m going to next, that quiets down. I’ll use the flat of my hand to slowly slide onto the neck, and I'll just wait there for a while and ask how they’re feeling, maybe we’ll take some nice guided breaths together. Then I'll verbally guide them through everything I’m doing with the neck, asking if it feels okay and checking if the pressure is right. While I’m practising consent I’m also monitoring the body and watching for any signs of stress or dissociation. The third part of consent is providing aftercare. I will hold their hand or cradle their head and ask them how they're feeling as the treatment comes to a close.
Is aftercare part of massage training or is that something you got from the kink community?
Definitely the latter. I also borrow the use of verbal affirmations from the kink community, I tell people they’re doing really well and praise them when a muscle releases. It’s part of active consent because it reiterates that they’re in a safe environment, but it also builds a positive neural pathway between embodiment and feeling good about yourself. Another thing I’ve taken from kink is an awareness of power dynamics, because during massage the body can go into a parasympathetic headspace where you can experience a low level of paralysis. So I let people know beforehand that could happen, and hold space for the fact that I’m in a position of power while they’re vulnerable.
Are there any other touch-based communities you borrow from?
Yes, I’m really inspired by the level of aftercare tattoo artists give to their clients and the extent they go to make them feel comfortable. I’m also inspired by tantric massage and somatic therapy. We have this idea, particularly in the Western world, that we have to justify receiving therapeutic touch, and you can only access it because you slipped a disc or sprained an ankle. What I like in tantric massage and somatic therapy is there’s an understanding that people need access to touch even when they’re not injured. Those therapies also use forms of breath work which I use as well.
Do you see your work as activism?
Definitely. I spend a lot of time undoing the impact of transphobia and a lack of access to healthcare on people’s bodies. People who come to see me often haven’t seen healthcare professionals for a very long time due to discrimination or previous bad experiences. Often I'm the person who will find the lump on their body, or who feels the warning signs of HIV. I spent a long time wrestling with impostor syndrome and feeling like no one else in this industry looks like me or does things the way I do, so the fact that I’m in the room also feels like a form of activism.
How do you cater for neurodiverse people in your practice?
It’s about recognising differences in touch and sensation. A lot of people will want to feel or smell the oil before it goes on their body. I have various scents, or we can work without oil or even through their clothing. I also give people a choice of noise, they can have silence or chatter from me. Recently I had a client with ADHD who really struggled to sit still, so we played their death metal playlist. Hearing lights up the brain more than any other sensation, so music can stimulate that part of the brain that’s looking for extra movement and action and help people be calm. I also have fidget toys people can play with, and they can bring along safety items like a hoodie with a familiar smell.
How do you support transmasculine clients undergoing surgeries?
Preparing people for top surgery is about predicting what pain patterns will show up based on the state of their body pre-surgery, and giving self massage techniques and stretches to offset some of the pain. They reroute the nipples during top surgery and afterwards people's heads haven't quite caught up with having a new body, so I do a lot of work putting their hands on their chest, which also helps to reduce dysphoria. Phalloplasty has a very high complication rate, and even without complications it’s two to three surgeries. Currently due to NHS waitlists revision surgeries are not being carried out, so there’s a lot of people who need help reducing pain.
What about transfeminine clients?
Vaginoplasty is also multiple procedures and there’s a lot of complications. This can range from serious physical complications to ongoing issues around reconnecting with the body. I’ve supported a lot of trans patients after vaginoplasty who haven’t been able to access orgasm because they’ve experienced so much disassociation around the genitals. So I’ll support them towards feeling sensation in that part of their body again by doing breath work and asking, Can you feel my hand on your thighs? Can you feel my hand on your pelvis? And encouraging them to really soak that in. I'm very proud when they message me afterwards and say they’ve had an orgasm at home. I'm like, Yes! Welcome to your new vagina.
What are some of the most magical things you've experienced with clients?
Moments where I’m looking at a beautiful trans body which feels safe and relaxed, and everything is soft and splayed. People’s faces look different when they feel safe as well, that’s always something I notice. Their faces look so different at the end.
Words by Helen Gonzalez Brown. You can follow Ana’s work at @therealmassage or visit her website here. If you enjoyed this newsletter, please consider forwarding it to a friend.
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