How to Work Safely and Confidently with Complex Massage Clients

Practical insights on safeguarding, communication, and professional confidence

Working with complex clients should now be seen as standard practice in massage therapy. Chronic illness, neurological conditions, trauma and multiple health issues aren’t exceptions anymore. Around one in six people in the UK lives with a neurological condition. Yet many therapists still feel uncertain about safety, communication, and how to adapt their approach when things aren’t straightforward.

That uncertainty doesn’t mean you should avoid complex clients. They’re often the ones who benefit most from massage therapy.

Understanding What “Complex” Really Means

Our brains are wired to confuse “complex” with “difficult,” but complex doesn’t mean difficult. When you stop labelling something as “difficult,” you take away some of the negativity that surrounds it. Complex simply means there are more factors to consider. It might involve multiple health conditions, communication differences, sensory sensitivities, or circumstances that shape how someone experiences touch and movement.

Clients recovering from stroke, living with MS or Parkinson’s, managing chronic pain or fatigue, carrying trauma around touch, or navigating learning disabilities and communication differences each bring their own needs. For massage therapists, the key is awareness. Notice what might affect comfort, safety, and consent before you even begin.

Reframing “Complex” as Just “Human”

After you’ve worked with enough people as a massage therapist, you start to realise that “complex” is just another word for “human.” Everyone brings stories, challenges, and needs, some visible, some not.

The human body rarely does what you expect. Muscles tighten, nerves misfire, symptoms come and go. Many of us were trained in sports massage, where the goal is to identify the problem and ‘fix’ it. Working with complex clients, you're not trying to correct or control. You’re learning to listen and adapt to what each client needs that day. Sometimes the goal isn’t to fix anything; it’s to bring relief, comfort, or rest.

For some clients, that might mean easing pain or helping them sleep. For others, it’s simply creating a space where their body feels safe enough to relax. And for these clients, that can be as meaningful a breakthrough as fixing a sports injury.

As more people live with complex health conditions, this kind of adaptable, responsive work needs strong foundations. That’s where safeguarding comes in. It makes sense that massage therapists need a clearer understanding of safeguarding, not as red tape, but as part of building safety and trust for everyone involved.

Good safeguarding is practical. It means asking the right questions, noticing when something doesn’t look right, and knowing when to pause or refer on. It keeps sessions professional and protects everyone involved: the client, the therapist, and the reputation of massage therapy as a whole.

When you treat safeguarding as a living skill rather than a form to fill out, it becomes part of how you create trust. Clients feel safer, and you work with a clearer mind.

Communication is everything

Most problems in massage therapy don’t come from technique. They come from something getting lost in communication.

In my experience, from running a clinic, teaching massage therapists, and working on the CNHC Profession Specific Board, communication is the skill that keeps everything safe. Most client issues, complaints, or misunderstandings don’t start with bad intentions. They start when what’s said, heard, or understood doesn’t match.

Use plain, honest language. Skip the jargon. Instead of “releasing fascia,” try “you might feel your arm moving more easily” or “you might notice some warmth here.” Check understanding properly, don’t rely on polite nods or small talk. Ask clear, grounded questions: “Is this pressure still okay?” or “Would you like me to stop if it feels too much?”

Remember that communication isn’t only words. Some people need extra time to respond. Others use gestures or devices. Silence can be part of how they process. Pay attention to breath changes, tension, and expression; they often tell you what words don’t.

And when you don’t know something, say so. “I’m not sure, but I can find out” builds more trust than guessing ever will.

Clients aren’t looking for perfection. They want to feel understood. Our hands might be our number one tool, but communication and intuition are a close second. Being able to listen, notice, and respond in real time matters more than any technique.

Building Actual Confidence

Confidence isn’t about knowing everything. It’s about how you handle the moments when you don’t.

You can’t predict every scenario, but you can prepare for the kind of clients you see most often. If someone mentions dystonia, spasms, or fatigue, it’s ok for you to take a bit of time to learn what that means for your approach. Talk things through with other therapists. Sharing tricky sessions helps you learn, gain perspective, and stop overthinking.

Confidence also grows through reflection. After a session, note what went well and what you’d change. That’s how experience turns into skill. It keeps building when you stay curious, keep learning, and keep communication open, asking questions, checking understanding, and being honest when you don’t know something. Clients trust that far more than a false certainty.

And confidence gets stronger when you take care of yourself. A calm, rested therapist helps clients feel safe before a single word is spoken. Your breathing, pacing, and recovery time are part of the work, not a luxury.

Confidence doesn’t come from having no fear. It comes from having enough structure and awareness that fear doesn’t take over.

When Sessions Don’t Go as Expected

Bodies are unpredictable, especially complex ones.

In life, things rarely go exactly to plan. The same is true in the treatment room, especially when you’re working with complex clients. Bodies don’t always respond the way you expect. A muscle spasms, a client flinches, a movement doesn’t go as planned. Sometimes it’s physical, sometimes emotional, and sometimes it’s just a mystery.

These moments can feel awkward for both therapist and client. But they don’t need to. A calm, relaxed response, maybe even a shared laugh, resets the tone and reminds everyone this is human, not a performance. What matters isn’t perfection, it’s how you respond when the unexpected happens.

Adaptability, warmth, and presence do more for safety and trust than any flawless technique ever will.

Complex care hasn’t had much attention in massage therapy, yet it touches more clients than most realise. Bringing awareness to it strengthens the whole profession and helps massage therapists feel more confident and prepared.

About the Author

Gemma Eves is the founder of NeuroMassage, an award-winning clinic specialising in neurological conditions and complex care. She created Neuro Training School, the world’s first internationally recognised and insurance-approved neuro massage training provider. An inclusive wellness advocate, Gemma teaches therapists worldwide to work safely and confidently with clients with neurological conditions, chronic pain, and complex needs.