Sol Benson loathed her body. It went beyond mere embarrassment at how “fat” she was. Deeper still was the conviction that her body was unworthy of love, was deserving of nothing that felt pleasurable or nurturing.

And it was that alienation from her own body that for years kept Benson, a professional dancer who has waged a lifelong battle with anorexia, from getting the massage she knew would be so helpful to her. “I stayed away because getting a massage was being good to myself,” said the 45-year-old Colorado mother of two, whose own mother and brother are massage therapists. “If I’m on a weight loss cycle, it’s like ‘I don’t deserve love, I don’t deserve food, I don’t deserve to feel good about myself.’”

Benson credits Mary Rose—a Boulder, Colorado, massage therapist who has developed a special style of acupressure particularly appropriate for the physically fragile—with understanding her particular psychological fragility enough to help her turn massage into a tool for healing, rather than a doorway to despair.

It was the tender care from Rose, Benson explains, that helped the process. Her nonjudgmental ways helped Benson maintain balance. If, however, Rose had brought up weight, or in this case, the lack thereof, Benson admits it could have sent her into another purging cycle.

Benson’s story illustrates just how complex the issues of body image can be in 21st century America and how massage therapists need to be careful as they negotiate this potential psychological minefield with clients.

“What you see may not be what they’re seeing,” says Rose, who supervises the massage therapy program at HospiceCare of Boulder and Broomfield counties, and who developed Comfort Touch in response to the special needs of massage clients in medical settings. “You can’t invalidate what they think they’re seeing because they’ll think you’re lying. You simply can’t say anything that’s value laden, good or bad. That’s the message I’d convey: never say anything about body weight. That’s my policy, no matter what weight people are.”

With America in the grip of an obesity epidemic—while at the same time holding up waif-like thinness as a cultural ideal—many people are worried about excess pounds and the harsh judgments that accompany them. Embarrassment at the thought of uncovering imperfect bodies for the close contact of a massage or bodywork session drives away untold numbers of potential clients.

The problem isn’t limited to issues of weight. Many people avoid massage because of embarrassment about acne, surgical scars, birthmarks they consider unsightly, or some other physical deformity or flaw.

“A really common one is, ‘I have such ugly feet,’” Rose says. “I always laugh and say that in 20 years, I haven’t seen an ugly foot yet. People just have bad attitudes about their feet. In general, people are so self-judgmental.”

Putting clients at ease and reassuring them that they will not be judged by their physical appearance requires considerable skill and intentionality on the part of the massage therapist.

“This is something that’s so prevalent and something we deal with daily,” says Jonathan Burt, 27, a Detroit massage therapist and massage instructor. “I can’t tell you how often I’ve heard, ‘I have to wait until I get into shape before I come in for a massage.’ They think they have to be in shape before they can relax.”

Given the increased blood flow that results from massage, as well as the benefits to the lymphatic and other body systems, Burt believes obese people and others who suffer from limited mobility are the people most likely to benefit from a good massage. That’s why he especially treasures his overweight clients.

To lessen discomfort, Burt says he stresses to all potential clients that their bodies will always be draped. And he lets clients know that he identifies with their fears. “We all have flaws,” says Burt, who gave his first massage at age seven, when his grandmother, a double amputee, asked him to massage her stumps. “Myself, I’m not the American Gladiator. I inform people I have flaws as well, and I’d be more than willing to help them overcome their self-consciousness.”

Equally important is the demeanor of the therapist. Compassion for the client is paramount.

“People come to the table with all different kinds of baggage, their own image they create of themselves,” says Charlie Murdach, 38, a Portsmouth, New Hampshire, massage therapist. “For me, it’s meeting the person where that person is and addressing that person in an appropriate and compassionate way.”

Murdach, who has been a massage therapist since 1990, says he has yet to meet a potential client that he can’t help, regardless of that person’s physical condition. He credits this to his ability not to try to force anything, but to also being open to the possibility that miracles can happen.

“Whatever is going on with that person, whether it’s a deformity or some type of disability, I make sure I can step up and hold the waters calm for that person,” he says. “The key is, from the initial conversation you have with a person, before the person even comes in, you start talking to them in a way that’s understanding and compassionate. When they show up, they show up with whatever they have. It doesn’t matter if they’re missing an arm, or have a deformed hand, the person who is standing there desires to move forward.”