Many people assume that touch-based therapies such as Shiatsu are unsuitable for autistic people with complex needs because of their neurological and sensory differences.
However, my experience has shown me that the possibilities for touch therapy are much wider than conventional wisdom might suggest.
When people ask whether an autistic person can receive touch therapy, they may be imagining a conventional treatment session: the client lies still on a mat, the practitioner follows a familiar sequence, and the session lasts for a set period of time.
That format is possible for some autistic clients, but not for everyone, and much can be achieved by stepping outside conventional practice.
Over a period of seven years, I have worked with around 30 autistic clients, visiting them at their care homes or day centres, for weekly sessions. All of my clients had high support needs, most were non-verbal to varying degrees, and most had significant sensory challenges.
In my work, I managed to engage each of the clients in a touch therapy routine based on my training and experience as a Shiatsu practitioner.
This does not mean that every client received a complete, standard Shiatsu session; in most cases, the treatment had to be adapted considerably. Still, a routine of therapeutic touch could be established for each client.
Mindset
Early on in my work with autistic clients, I made the decision to assume that a client who did not immediately accept touch was not unable to receive it. I submitted myself to a process which involved careful observation, patience, and creativity. I had to discover what was possible for that particular person, without forcing anything.
Achieving even a very short session with a client demonstrates potential, not failure. Sessions shaped around the client’s capabilities and preferences were tiny steps through a door that could open to longer and richer sessions.
Throughout the exploration, the aim was not to overcome the clients’ reluctance to accept touch, but to discover how an acceptable form of touch was possible for them. Respect is key.
Consent
One challenge I faced when working with non-verbal clients was establishing their consent to participate in the treatment. Although I only worked with my clients after obtaining consent from their parents or legal guardians, I was wary of forcing people to take part in activities they did not wish to participate in, particularly when some clients could not clearly communicate their approval or disapproval.
I had to look for demonstrable willingness to participate, which could take different forms. This might include waiting for clients to engage with me first, allowing them to hold and guide my hands, or observing whether they moved away and later returned voluntarily. When I was unsure, I relied on the knowledge and observations of support workers who knew each client and their individual signals and preferences well.
Note that absence of an expressed refusal does not mean agreement. A client may remain still for different reasons, even when they wish to stop participating. Similarly, willingness to engage at one point does not necessarily mean consent to every subsequent interaction. Continual observation is essential, looking for any signs of unease or objection and remaining attentive to changes in the client’s willingness to participate.
A Shiatsu core
If I were to fixate on a conventional Shiatsu format, most of my clients would be unable to participate at all. But the conventions are not an absolute requirement for meaningful therapeutic contact.
I adapted my way of working to make the most of what my clients allowed and presented to me, but kept myself rooted in the principles of Shiatsu. That could be in incorporating the hara (the Japanese term for lower abdomen area) in every movement, the technique of hand pressure, the selection of points and areas to touch, and meditative practices during the session.
By using the core principles of Shiatsu as a starting point for exploration, while allowing the interaction to evolve according to each client’s needs and responses, I found diverse ways to engage clients, with a potential for therapeutic benefits.
Participation
Participation took various forms. Some clients were able to lie on a mat for approximately 45 minutes. These sessions could resemble a more standard Shiatsu treatment. Other clients participated for shorter periods, sometimes around 10 minutes. Some sessions were frequently interrupted. Some clients received treatment while sitting on a sofa, and in one case a client received treatment while standing.
With every client, I managed to establish a routine in which they would engage in touch therapy for sessions that ranged from 10 to 45 minutes. For most clients this happened in every session, but for some, engagement varied from one session to another.
I had to learn how each person communicated their preferences and observe how they responded to different interactions, positions and types of pressure. In some cases, it took many months; in others, it happened faster.
Some clients were relatively easy to engage. They might approach the treatment space or lead me by the hand towards the place of treatment and specific parts of their body they wanted me to work on. Their actions suggested that they were familiar with the process and willing to engage with it. Other clients were initially reluctant to engage in any form of touch.
It was satisfying to see clients who were agitated and alert become calmer during or after the session. Anxiety and agitation are common for autistic clients with high support needs, and an observable reduction in signs of agitation is meaningful.
The question is ‘how’
The title is therefore misleading. Instead of asking, “Can this be done?”, perhaps the more useful questions are: “How can it be done? How can I adapt the way I work and the way I think?”
Working with autistic clients taught me a great deal about Shiatsu, patience and autism. There are many other insights that I would like to share, and I hope to explore other aspects of working with autistic clients in future articles.