Massage therapists often ask me how to manage the emotional demands of working with people with cancer. The answers are individual, so I hesitate to share my own approaches if they might not honor another's.

Therapists are right to ask about managing strong feelings; our emotions can bounce all over our inner world when we work with people who are ill. Over years of this work, I've certainly gone through a range of feelings. I've felt elated after hearing a client's promising test result. I've felt dread after watching a client's condition worsen. I've felt unfinished when learning of a client's death before I had a chance to say goodbye. I've felt satisfaction from hearing a client describe symptoms of relief from massage. I've felt peace and joy when marking a client's five-year "survivorship" after cancer treatment. I've felt respect and admiration when sensing a client's strength as they manage hard treatments.

Therapists are right to ask about managing strong feelings; our emotions can bounce all over our inner world when we work with people who are ill.

And I've felt sadness and emptiness at a client's regular appointment time, looking out at an empty waiting room, reminding myself that my client passed away. I've felt sadness and emptiness that my client no longer has a body that needs my help or companionship.

These are ordinary human feelings, nothing unusual or out of place, yet I think they are deepened in a relationship of touch. When I touch a client's body, a body that bears the story of illness, treatment and healing, it makes a particularly deep impression on me. Even with a one-time client, I am moved. I have more to lose and more to gain as I let my client's life touch mine, as I walk with them in some small way along their journey.

Touch intensifies the connections between us. Add on the fact that massage therapists tend to be a sensitive lot, and the specter of possible emotions in this work can seem overwhelming. It's worth asking, "How do I manage?" and giving good thought to measures that might ease the way. Managing feelings doesn't mean stifling or ignoring them. It doesn't mean work without being affected by them. But as the "operations manager" of my own small life, I'm learning to create the infrastructure to weather the feelings that pass through me. To the extent that my approaches prove useful to others, I offer them humbly here. All are straightforward, and we've heard them before - but the call to do our work refreshes the call to take care.

1. Move each day. Massaging is great movement, but it doesn't qualify. Move by yourself and for yourself, in addition to your work. Move rhythmically. Walk, stretch or pound your feet around a park, if possible. Take a class in some kind of movement at least once a week, preferably something that requires full concentration. I choose from among the many activities that I have no aptitude for, since I can't think about much else while I learn. The stress relief is remarkable. In particular, I've noticed that fluid movements (cycling, skating) free my soul, and percussive movements (such as dance, kickboxing, jumping) jostle my feelings from their tight wrappings and release them.
2. Get professional supervision. Hire a skilled massage therapy
   mentor or a psychotherapist to listen to you regularly and confidentially. Go in and unload your thoughts about your work or the people around you or things that irritate you. Share pain and triumph. Present client cases and get help for difficult client situations. Problem-solve. Grieve. Fuss. Tell it like it is. Instead of fighting feelings or stuffing them, make room for them in an atmosphere of trust and care. The math is compelling: The more we express and clear out our own stuffed pain, the more room we have for the rest of our feelings and for the pain of others.
3. Get peer support or supervision. Talk with colleagues regularly and confidentially - colleagues who do similar work and understand what it gives you and what it takes. Seek out colleagues who listen carefully and ask questions, then listen carefully and ask more questions, then listen carefully and ask more questions. Find people who only offer advice when asked.
4. Mark the passing of a client. Go to the funeral, when possible. Acknowledge your client's transition and your own loss. Light a candle for a few minutes in a quiet space or in your treatment room, breathe and let yourself remember your client.
   The need for some sort of ritual became clear to me when my travel and teaching schedule conflicted with several clients' memorial services. I was in pain - isolated from the loss shared by other people who loved and cared for the person I loved and cared for - and I felt alone. I realized that missing someone was hard, but missing out on missing them was even harder! To honor my client's passing, I might write a letter and tell them how much I miss them. I tell them goodbye, thank them, tell them what I admire about them, how they changed or added to my life. Or I simply write, "I miss you." It moves me, helps me feel, and I like to think it's good for both of us as we part ways.
5. Surround yourself with people who "get" you; to whom you don't have to explain yourself. People who can eye your moods, let you be, let you complain when necessary, offer hugs freely. Populate your life with at least a few people who feed you well on every level.
6. Eat well. Take in greens and protein early in the day and eat more than a muffin for breakfast. Include vegetables that, when cooked, provide comfort. Eat good soup. Choose food that says, "I will support you in your work today." Take in food mindfully, with thanks and the sense that it makes you better, makes things manageable, gives you life itself. Crowd out poor food choices with good ones. Rely on good food, not caffeine or sugar, for energy.
7. Get plenty of sleep. Get even more when you've got a backlog, or when your work is particularly hard, stressful, overwhelming or sad.
8. Use wonderful body mechanics when you work. Watch yourself in a mirror sometime while you give a massage. If your shoulders are hiking, your head dropping, your joints becoming rigid, then stop and adjust. Get some movement therapy or advanced instruction in body mechanics. Be certain, in your concern for your client, that your body doesn't curl around the fixed object of the table/hospital bed or massage chair.
   Get your hips, knees, ankles and feet under you for support. Feel the length in your spine, the width in your shoulders; keep your rib cage from sinking into your pelvis. Let your jaw and brow loosen. Breathe. We are not all equally trained in good body mechanics and poor movement can be a major contributor to burnout in our profession. Become devoted to body mechanics if you aren't already.
9. Feel your own heart as you work. Breathe into it. With your breath, prepare a space behind your sternum for you and for your client. Sweep it clean of cobwebs and make it ready for your presence and for your client's. Welcome yourself into your own heart. Then welcome your client in, fully and warmly. If you find your welcome isn't warm as you'd like, see 2 and 3, above.
10. Heal. Dig deep, search wide, discover why it is that something provokes you, something else grieves you; why you're overwhelmed or tired or have a headache or are irritable; why you're drawn to this work. Ask yourself what hurts, what heals and listen for your answers. Write them down, talk or sing about them. Listen to the same song over and over if it soothes you or brings up feelings. Go get massage. Go to temple or church or yoga or psychotherapy or retreats or on vacations or home, if any of these will help your healing. Your own healing is vital. It is a lifelong journey. It is, every last bit of it, worth as much as your clients' healing, and it's worth striving for, praying for, fighting for and paying for.

Looking back on this list, I am aware that these suggestions may serve all of us, not just massage therapists working with a certain population. The humanity of our work bestows blessings and challenges on us all. And every little self-care measure counts - if not for our clients, at least for ourselves.