Pāhekoheko - Te Reo translates to English as: (verb) to combine, join, unite or integrate, (noun) connection, relationship

Interoception - mind and body connection, how intune one is with what their body needs or is experiencing

Neurodivergence - Individuals who do not have neurotypical brains, may have traits or a clinical identification as autistic or any other neurodivergent category such as ADHD, dyslexia, dyspraxia, or other.

Fascia - connective tissue that encapsulates and weaves throughout the musculoskeletal systems and organs of the body and houses the nervous system.

In recent years, knowledge of different aspects of neurodivergent types, such as Autistic, ADHD, Dyslexia and more, has become increasingly widespread and less stigmatised. Social media platforms such as TikTok and Instagram have rampantly spread information about what it means to have neurodivergent traits, enabling more people than ever to self identify, research, or even seek professional/clinical identification. Through this process, many of my peers, now working adults and parents, have found that they are not neurotypical, and are on an ever continuing journey to better reconcile what that means for them and their lives. In my own way, I have been coming to terms with my own Dyslexic brain, and am witnessing my cousin go through her own journey with Dyslexia. 

In 2024, I undertook a training programme called Myofascial Unwinding (MFU) with the rennowned ‘fascia guru’ Beth Beauchamp to upskill my massage practice. Her training on this course successfully taught me and many other body work practitioners how to better use their intuition and deep listening to facilitate a more impactful yet gentle fascial release in clients. This teaching transformed my practice, and better prepared me for the complex yet inevitable conversations and practices that I experience with my clients who are enduring trauma, significant change/transformation, and grief. Facilitating a deepening in a client’s interoception is something I pride myself as being a cornerstone of my massage practice. 

However, while these MFU practices typically worked well with my neurotypical clients, I continue to find roadblocks with these techniques in those who are or suspected to be neurodivergent. This is not a criticism of Beth Beauchamp’s teaching or work, in fact her work inspires me to deepen my own knowledge about all manner of things. These roadblocks are significant because neurodivergent individuals often experience a reduced capacity for interoception due to the way their brain and body process their sensory input, and the way their brain prioritizes what they might focus on. This study, Project Pāhekoheko, is an opportunity for me to better understand neurodivergent individuals, and to provide a safe space for my practice and the neurodivergent participants to learn more about how interoception works for them. This study is donation and self funded and independant, but I hope will lead to broader and continued learning around interoception and neurodivergence. This study is not a means for any individual to be assessed or categorized under any neurodivergent category or diagnosis.

Interoception (and all aspects of mind-body connection) is an important part of how humans navigate ourselves and the world around us. For neurodivergent individuals, their interoception abilities are often limited or work differently to that of neurotypicals. Through this study, I will explore how massage can improve interoception for neurodivergent individuals and what that process needs to be in order to be consistently successful. 

The measurables of neurodivergent interoception that I hypothesize to be improved through regular massage includes but are not limited to: 

• Increased (and more accurate) awareness of bodily sensation, eg tension/pain.

• Positive/safe association with bodily sensation (related but not limited to building a healthier relationship with their body or with platonic intimacy).

• Increased (and more accurate) awareness of bodily systems, eg breathing or hunger.

• Increased engagement with parasympathetic nervous system and vagal nerve system(s), eg healthy self soothing or identifying/reducing chronic fight or flight response.

• Increased capacity to accurately understand and process one’s own emotions and trauma.

While I believe that massage is an ideal medium to navigate the relationship between interoception and neurodivergence, there will be many ways that massage (or at least my specific massage practice) will need to adapt in order to better support the needs of neurodivergent clients. These accommodations will become part of my standard way of working as I build a more inclusive practice.

The first phase of this study is crucial to my foundational understanding, and that is for me to gather more data from a range of sources, about these measurables. For this reason, I have created The Quiz which I am inviting all of my clients to take. You do not have to be neurodivergent to complete The Quiz. Interoception and massage is a wonderful thing to have information about, no matter who you are. However, it is my goal to hear the perspectives from a diverse collection of individuals, in order to get a better scope of how these measurables intersect in real people’s lives. As reading and question answering can be a hurdle for some, I have included an audio version of both the information you are currently reading, as well as an audio version of The Quiz, here . I encourage written or verbal responses which include informal chat during massage sessions. 

You may complete The Quiz after as many massage sessions as you like and whenever it suits. The ideal time to complete The Quiz is within 48 hours (before or after) a massage session. If the online quiz format doesn’t work for you, an email with your answers is also useful. Getting information about your experiences over time adds depth and nuance to my understanding of the relationship between regular massage and interoception. Every completed quiz is an automatic entry into my annual giveaway of 1x 90 Minute Massage, (to be drawn in January, 2026).

It is my intention to grow this project and further develop my massage practice along with it. It is my belief that when massage and all forms of health services are made more equitable and more inclusive, that we all thrive. It is my fascination and deep love for people that drives me to better my work. The better I can hone my craft to serve my clients, and by extension my community, the more fulfilled I feel in doing my job. Through massage, I feel that there is a unique opportunity to support individuals with neurodivergent challenges.

‘Unmasking Autism’, by Dr Devon Price, 2022

‘The Dyslexic Advantage (revised and updated)’, by Brock Eide MD and Fernette Eide MD, 2023

fasciaiq.com , Beth Beauchamp, 2024

‘The Body Keeps The Score’, by Bessel van der Kolk MD, reprinted 2015

‘Anatomy Trains’, by Thomas W Myers, 2020

Last updated: Jan, 2025

During 2025 more than 31 people have contributed to Project Pāhekoheko and at least 50% of these individuals are ongoing clients which means that I hope to continue and deepen these conversations over time. Over the course of deliberately pursuing my interest in neurodivergence and massage I have barely scratched the surface on both the breadth of experiences individuals have in their mindbody connection nor in my fascination for the subject. It is always both a delight and a relief to understand that we are all different and that there is no one correct way to experience massage or, in fact, the world.

At the start of 2025 I made some predictions regarding the intersection of massage and neurodivergence, and now, using the testimonies given in response to The Quiz, and using the notes taken from client discussions, I can reflect on these predictions:

‘Increased (and more accurate) awareness of bodily sensation, e.g. tension/pain.’

This prediction is true for both neurodivergent and neurotypical individuals, especially if the massage is done well. However, it is my observation that a neurodivergent individual is more likely to arrive for their massage with impacted interoception. This is either due to an overwhelm or emotional flooding, overstimulation, increased fatigue, or the experience of hyperfixating on a particular aspect of their life (eg one specific email from work) which inhibits their capacity to consider other aspects of their physical/mental state. With this in mind, over the course of their massage, one of two experiential patterns is more likely to take place: 

1. It takes the majority or all of the session to bring them to a state homeostasis and may require that we talk less and work through guided breathing and/or verbal cues to facilitate their relaxation. Without this process they may leave the massage session not realising they were tensing their legs or their hands (for example) the whole time. Or,

2. At some point during the massage the client does experience deep fascial and/or muscular release and they experience this very intensely and may even find it strange and disorientating while their brain recalibates to this new normal. Without verbal discussion and reassurance, the client may leave the massage feeling “weirded out” or confused by what they are experiencing. 

While it is often a justified goal in increasing one’s awareness of their body for the purposes of healing, one cannot assume that the recipient has the internal tools for navigating both the sensory and emotional changes that body work may instigate. If the recipient has a confusing experience in receiving massage, it may become a barrier for care and turn them away from massage services or, in extreme cases, other health services that require bodily touch.

‘Positive/safe association with bodily sensation (related but not limited to building a healthier relationship with their body or with platonic intimacy).

This aspect is a great example of Rome not being built in a day. It can take a lifetime for anyone, neurotypical or otherwise,to improve their relationship with their body. For this aspect of the study, I am drawing on the testimony of clients I see regularly and have done so for at least 6 months. One such client, after having been coming to me for a massage for over a year, told me that deep tissue release work feels “yuk.” When I asked her to expand on this she explained that feeling muscles resist release and then gradually releasing feels “like something I shouldn’t be feeling.” She further expressed that she prefers to think of internal sensations of the body as internal only and external sensations as external only, implying that deep tissue massage is, in her experience, making an internal experience an external one. This, mixed with the social conditioning that bodily functions and anatomy are “gross” and “private” makes for an intense and often unsettling experience for her on the massage table. However, her body functions better and she has a reduced experience of pain in the days and weeks following the massage sessions, so she is willing to endure this “gross” experience for an enjoyable outcome. All this to say that if a person is, by definition, confronted by the textures and sensations of their body, one cannot assume that the massage, by definition, is relaxing. Education can be helpful, but one needs to be wary of the language used to communicate with their client. Detailed anatomical language may remind them of surgical medical environments, and too much talk of blood circulation may evoke squeamishness. This language, the “ick” factor, and a client’s level of knowledge are all factors to consider in the case by case practice of building an effective rapport with the client. 

The way a person relates to their anatomy is largely dictated by their inner beliefs about who they are and who they are not. For everyone, these beliefs are woven over their lifetime from as early as birth by way of their brain responding to their experiences of being in the world around them, experiences which are received by way of all 5 senses: taste, smell, sight, sound and touch. It is no wonder that the type of brain you have (neurodivergent or otherwise) and the way you experience touch, such as massage, is complex and innate.

‘Increased (and more accurate) awareness of bodily systems, e.g. breathing or hunger.’

And

‘Increased engagement with parasympathetic nervous system and vagal nerve system(s) e.g. healthy self soothing or identifying fight or flight responses.’

The most common feedback from those who identify as neurodivergent who completed The Quiz in written form was that when they left their massage they were more aware of hunger, fatigue, or posture than they were when they arrived for their massage. For some, this wasn’t a significant observation, but for those who have struggled with disordered eating patterns due to a neurodivergent lack of hunger or thirst awareness (part of interoception) this was a profound discovery. The idea that they could both actively bring on a sense of calm or a window of accurate hunger perception by going to have a massage was both inspiring and wonderful. One neurodivergent client spent her entire hour-long massage with me trying to find the words to describe the feeling in her body. At the end of the session I was able to tell her, “what you are describing is calm, this is what calm feels like.” This session was as insightful for me as it was for her who, upon learning that when she feels calm she becomes hungry, now orders food to be delivered to her home so that after her massage she can eat right away. It seems that after her massage, her system has a brief window of being out of the Fight of Flight state, a state during which hunger signals are blocked in favour of getting away from danger. Only, for many neurodivergent individuals living in a modern world, something as simple as a tag on their clothing can be so overstimulating that it puts them in the hunger squashing Fight or Flight state. The more than I learn about the Vagal Nerve theory, the more I am interested in continuing with this learning in the future.

‘Increased capacity to accurately understand and process one’s own emotions and trauma.’

To say that I have barely lifted the lid on understanding the intersection between neurodivergence and trauma is an understatement. In terms of my massage work, I may not have even confirmed the boundaries of the lid itself. So complex, so person specific, and so innately unpredictable is trauma work. This said, a pattern has emerged with my autism spectrum and ADHD/AuDHD clients which is that massage provides a unique opportunity to better understand cause and effect patterns within their mindbody system(s). For many neurodivergent individuals, the desire for routine and precise or binary outcomes can make complex or ambiguous realities challenging to accept or understand. The body has many contradictions and vaguenesses that make bodily experience seem overwhelming or simply confusing to those who think in a binary, all-or-nothing way. One of my regular long-term clients has been rehabilitating a leg injury that to her frustration has been interrupting many of her preferred daily routines. Some days she would come to a massage session with a high level of pain but speak very calmly and matter-of-factly about her pain. She would accept the subsequent changes to her rigorous routine easily. Other days, even with a much lower overall level of physical pain, she would be nearly in tears at having to drive to work instead of walk as usual. As I got to know this client, I was able to give her my observation that her distress about her pain, and often her pain level itself, is much higher if she can easily identify what caused the flare up of pain. If the flare up appeared to her to be “for no reason” or if she couldn’t work out if the pain had been caused by Activity A or Activity B, her level of distress and therefore the level of pain she experienced increased. Once we talked about her desire for logic and predictable patterns and consistent outcomes, she began to better understand this relationship. She has started responding to her pain as it is, rather than trying to intellectually understand how she got there, which isn’t always possible or useful for her ongoing recovery. Amazingly, once she gained more acceptance of her fluctuating pain levels, her distress in not being able to predict them has decreased, and along with it, her experience of the pain.

In conclusion, it needs to be said that no one, including massage therapists, should set out to “fix” neurodivergent individuals (or anyone else for that matter). However, in deepening our understanding of interoception, and how brains and bodies receive and respond to touch, helps us understand what is possible between massage therapist and client. Some come to their massage therapist for relaxation and down time, others come to improve the function in a particular body part. Some clients come to process emotions, and some come to better understand their body. As a massage therapist I can never assume or judge the person’s reason for being there, nor is it my place or a useful stance to judge what a person does or doesn't know or sense about their own body. 

Now, for every new client or client who has changed their own reason for seeking massage services, I will often discuss if they have a visual mind's eye or not. If they don’t have a visual mind’s eye, I won’t do any guided visualisation work as it will not be effective. Further, I will make a point of getting to understand how this person understands their body, especially if we are working on rehabilitation e.g. how squeamish are they? Do they notice when they are hungry or cold? Are they very sensitive to textures and/or have an unexpectedly high pain threshold? As I get answers to these questions it helps me to adjust both the manner in which I do informed consent and also how I talk to them about pain. If a client has been living with high levels of pain but does not have the interoception to understand what that pain is telling them, then these conversations are important in order for me and the client to understand what massage approach is going to be constructive. I always want to understand their pain and aim to reduce it, not add to it by assuming my approach will work for them because it worked for someone else with the same injury.

As I head into 2026, I continue to deepen this work and find new ways to connect with clients who are in the process of connecting with themselves. In the last year, more than 6 of my clients, unrelated to their massage sessions with me, have as adults been formally recognised as ADHD and most are now trialing medication. Listening to their testimony and how their mindbody journey is progressing is fascinating and exciting. There is a seemingly endless path of learning and unlearning not only for adults living with newly identified neurodivergence, but for all of us. Sometimes, it is useful to think of a message like this: imagine if you thought in terms of yes and no and nothing in between. You don’t like hugs and you cut all the tags off your clothes so you can focus on your work. You understand how to behave in social situations because you have copied others over time and created rules that you follow to the letter e.g. if you are meeting someone for the first time do not touch them unless you're at work then shake their hand. Once you've met them 5 times, you can hug them but if it's at work it is 10 times. If it's your boss do not hug them. Your back hurts so your doctor recommends you get a massage so you book one. When you go to your massage you're expected to both talk about your pain and your body while wearing just underpants while someone you just met is touching you. 

Or, you could think of massage in this context: You’ve always been anxious but your great grades and high achievement distracted from your inability to focus on topics you weren’t interested in. As an adult you're a great manager with a knack for working with teams of people and you make friends easily, but never text anyone back and are constantly forgetting things. Your friend tells you they're worried you're going to burn out and book you a massage. You're late to the massage so you arrive sweaty and out of breath but don’t notice you're hot until you're handed a cup of cold water. Your massage therapist asks what you need and you get distracted by the smell of the oil she is using and spend half the session talking about a perfume making project you started 6 months ago but couldn’t finish because you were also renovating your car. In the days after your massage you realise it's the first time in over a year that you've gone more than 48 hours without a migraine headache, something you never thought possible.

Massage is different for everyone and I am beginning to understand that one’s internal experience is what makes the massage, and not just what techniques are offered.