Safe and Sound: Developing a Trauma-Informed Approach to Spa
by Kristine Huffman

Massage will help you release tension and makes you feel great. Meditation classes help calm your mind so that you can feel at peace. Getting leaner will lift your spirits. Taking time out from your busy life will help you relax and recuperate.

ASSUMPTIONS LIKE THESE abound in our industry. We promote the idea that feeling the healing power of touch, finding quiet spaces, and having a slim, healthy body makes everyone feel great. But what if these experiences actually create discomfort and anxiety for some of us?

Sadly, at least 70% of adults in the U.S. have experienced some type of trauma, and approximately six to 10 percent of those traumatized individuals may develop diagnosable Post Traumatic Stress Disorder (PTSD). Those who are traumatized may not experience touch as a pleasant thing at all. When their minds move to a quiet place where they are not distracted by tasks, they may experience disassociation, deep depression or even flashbacks. And the idea of having a slim, attractive body may trigger discomfort at the thought that it may attract the kind of attention that they associate with a previous assault.

Responding to Trauma
According to the National Center for PTSD, trauma is described as: “a shocking and dangerous event that you see or that happens to you. During this type of event, you think that your life or others’ lives are in danger.” Trauma may be experienced in a one-time incident like an accident, assault, living through horrific natural or man-made disaster or through a series of events that take place over time beginning in childhood and accumulating throughout life, creating damage that goes beyond bruises and broken bones.

In his groundbreaking book The Body Keeps the Score, trauma expert Bessel van der Kolk, M.D., informs us that trauma can “reshape both body and brain, compromising sufferers’ capacities for pleasure.” Since this re-wiring of our nervous system happens at a physical level in the sensory processing centers of the brain, when triggered, it literally blocks out our ability to think logically and process data. As a result, we move into physical and psychological stress responses that may include the urge to fight, flee, freeze or even lose consciousness.

When in this distressed state, we can’t access the thinking brain or experience positive feelings if the nervous system has identified something in our environment as potentially dangerous. So, a gentle touch on a particular spot of the body may be unconsciously perceived as the prelude to sexual assault and make us flinch. A startling noise, like the chime at the end of a spa service, may automatically cause us to duck for cover, and even the ubiquitous smell of lavender at the spa might remind us of a violent parent who wore that scent and make us uncomfortable and vigilant.

This doesn’t mean that spas should stop offering and promoting their services, nor does it mean most guests don’t enjoy them. In fact, those services can be a powerful healing agent for mind, body and spirit. According to current thinking among trauma treatment experts, body-mind approaches combined with specialized trauma treatment modalities are much more effective than traditional talk therapy. However, if we want to better serve individuals struggling to heal from trauma, we must examine our assumptions and shift our approaches to help them heal.

Many organizations have begun to reconstruct their customer service guidelines to include the tenets of Trauma-Informed Care. These principles were originally designed by agencies who served veterans of the Vietnam War and have been embraced by a growing number of medical and mental health providers and other organizations to support clients and coworkers who may suffer from trauma.

One long-time ISPA Member, Canyon Ranch, has made this a focus over the past few years. “We began to create a culture and environment of trauma-informed care, which means that on every level, from the top leadership on down, we introduce this idea of trauma. We are actively shifting our focus in terms of management into a trauma-informed one,” said Amy Hawthorne, life management director at Canyon Ranch in Tucson, Arizona, during ISPA’s Stronger Together Summit in 2021. “This means that we walk out into the world and interface with colleagues and guests with a level of empathy and understanding that we might not have had.”

A Trauma-Informed Approach
Unlike Canyon Ranch, your spa may not have an in-house team of psychotherapists to help create a more trauma-informed culture. But you can still take steps to transform your organization so all guests will have the opportunity to truly enjoy a spa experience.

One place to start is The University of Buffalo’s School of Social Work’s online resource center, which suggests examining how the following concepts play out in your environment, culture and standard operating procedures:

- Safety – Creating areas that are calm and comfortable
- Choice – Providing an individual options in their treatment
- Empowerment – Noticing capabilities in an individual
- Collaboration – Making decisions together
- Trustworthiness – Providing clear and consistent information

Let’s examine these ideas in the spa using a trauma-informed lens.

Since most spas are intentionally designed to be peaceful sanctuaries, the environment creates a backdrop for calm, comfort, and safety. But the space is only a part of this equation. The more important consideration is how the interpersonal interactions and energy in the space help people feel safe.

FOR CONSIDERATION: As you examine your guest flow and your employee work experience, look for ways to make people feel welcome, heard, appreciated and understood. Ask yourself: Are there any jarring sounds, lights or smells? How are transitions handled when a guest goes from one space to another or employees move between service encounters? How are guests acknowledged in each space or interaction? Are your employees trained in both verbal and non-verbal communication cues so they are on the lookout for guests or coworkers who may be uncomfortable or distressed?

Choice, Empowerment, Collaboration
Ideally, treatments and classes offered in the spa are designed with informed consent, collaboration and empowerment in mind. Service protocols typically outline procedures instructing the provider to introduce the service, give an overview of the service to set expectations, ask relevant questions about previous experiences, preferences and offer choices along the way regarding music, temperature, depth of touch, aromas, products, etc. and then act on the guest’s responses.

We should also consider these factors in developing all standard operating procedures (SOPs) throughout an organization to help employees have an optimal amount of control over how they do their jobs, as long as service standards are achieved.

FOR CONSIDERATION: As you examine each of your current SOPs, see if there are ways to invite more realtime feedback, enhance the feeling of control and give more choices along the way. Find ways to make sure that all employees are dedicated to these ideals and understand the importance of each step. Ensure that ongoing training, coaching and quality assurance checks take place to guarantee that every interaction in your facility meets your service standards.

Trustworthiness: Even under the most ideal conditions, with great SOPs and attentive team members, things sometimes go wrong. A person suffering from the effects of trauma may have a deep desire to experience peace and tranquility and seek out experiences that advertise these as outcomes. Ironically, they may also be physiologically unable to enjoy the experience and end up deeply disappointed instead. In other cases, the calm, quiet surroundings in our services and classes may allow bad memories to surface and lead to a breakdown or emotional crisis. The resulting stress response may make them act aggressively, become anxious or withdraw into themselves, and because this may be happening at an unconscious level, they may not realize why they’re feeling the way they do and blame the provider for doing something wrong.

FOR CONSIDERATION: When these individuals are experiencing intense emotions, spa staff needs to recognize the symptoms and be ready to help. When reviewing your conflict resolution and emergency procedures (and as you observe your employees’ behaviors), keep trauma-informed approaches in mind. Focus on increasing feelings of safety, connection and collaboration. Ask yourself: What happens when someone gets upset? Do my employees lean in to appreciate feedback, act when someone is unhappy, push for more information when a guest responds that a service was just okay and take action when someone appears to be in distress? Or do they ignore, back away, resent and gossip about the guests or coworkers who are experiencing these emotions?

Taking Action, Step by Step
When developing your spa action plan, consider the following transformational steps.

START AT THE TOP: One reason Canyon Ranch successfully implemented their program is that they approached the program, “from the top leadership on down.” Make sure you have buy-in at every level so that it becomes part of your spa’s mission, vision and values.

CONNECT: Find a local organization or practice that specializes in trauma treatment. Invite them in to teach your employees about the stress response, how to identify symptoms of PTSD and how to best help someone in distress. Develop a referral network of providers so that your services can complement their therapies. Building these bridges will allow your employees will feel safe referring their clients for the kind of body-mind work they can’t do, and you’ll feel safe referring clients for psychotherapeutic services that you can’t do. Keep in mind that ethical best practices mean that you’ll need to follow HIPAA regulations when you share information about your guests. And remember, there should never be a financial reward for referrals of this kind.

OBSERVE: Before you act, examine your organization through your new trauma-informed lens. This may be difficult to accomplish alone, so inviting a local trauma expert to spend an experiential day at your facility might be helpful. Use the questions in this article as a guide to help identify systems and SOPs that need change.

PRIORITIZE & REVISE: Once you’ve identified what needs work, prioritize the changes that will have the greatest impact. Set up a schedule and work through your list with your employees to co-create new SOPs. Having your team involved benefits you in two ways: It helps distribute the work so you’re not doing it all, and employees will feel more empowered and invested in the outcomes.

TRAIN: Once you have a new SOP, conduct regular training to ensure full understanding and commitment to the new procedure. Ideally, once a new SOP is launched, you should check back in regularly to get feedback in case there are any questions or concerns that come up. Make customer service process reviews a part of every staff meeting.

MONITOR AND REWARD: For best cooperation and compliance, you’ll need to develop a quality assurance program, or add this to the one you have in place. Consider adding relevant questions to your customer feedback forms, conducting regular secret shopper reviews or implementing peer-to-peer employee or management recognition programs.