Shiatsu (Namikoshi) and Zen shiatsu (Masunaga)

1. Introduction

Version followed: two styles described side by side. (1) Namikoshi-lineage shiatsu, taught in Japan under the national anma-massage-shiatsu licence (Act No. 217 of 1947 as amended). (2) Shizuto Masunaga's Zen shiatsu (Iokai lineage), as his own texts describe it in German translation (Shiatsu Journal 50/2007) and as UK shiatsu is credentialed under the CNHC core curriculum (April 2023). This guide is for the psychotherapist. Shiatsu is delivered by trained shiatsu practitioners, not by the psychotherapist. For the older Japanese massage form it grew out of, and for the shared Japanese licence, see 024 Anma.

What it is. Shiatsu is a Japanese hands-on therapy. Its name means "finger pressure". It combines pressing, kneading, tapping and stretching, and the client stays clothed, usually lying or sitting on a floor futon [source: Cancer Research UK]. Japan's Ministry of Health is reported to define it as pressure from thumbs, fingers and palms, with no instruments [source: Wikipedia, citing MHLW; uncertain: the ministry's own text not verified]. Historical accounts trace a separate shiatsu identity to Tamai Tempaku's Shiatsu Ho (1919) and a 1925 therapists' association that set shiatsu apart from anma [source: Wikipedia, citing Anderson 2008; uncertain: not verified in primary sources].

The two styles.

Namikoshi. Tokujiro Namikoshi founded a shiatsu college in the 1940s and is often credited with modern shiatsu. His style is taught within a Western medical-science framework of anatomy and physiology, not meridian theory [source: Wikipedia, citing Anderson 2008]. The Japan Shiatsu College (日本指圧専門学校), run by the educational corporation 学校法人浪越学園, calls itself Japan's only vocational school specialising in shiatsu. It prepares students for the national あん摩マッサージ指圧師 examination [source: best-shingaku school profile]. The founding year and the 1955/1964 legal-recognition milestones are [uncertain: not verified]; see Framework.
Zen shiatsu (Masunaga). Shizuto Masunaga brought traditional East Asian medicine and philosophy back into shiatsu. He founded the Iokai Shiatsu Center [source: Wikipedia, citing Anderson 2008; Jarmey & Mojay 1991]. His texts describe twelve meridians, which he later mapped beyond the classical channels. They also describe a diagnostic polarity of kyo (deficient, hidden, usually the root) and jitsu (excess, on the surface, the symptomatic pattern), read mainly by abdominal (hara) and back palpation [source: Masunaga, Shiatsu Journal 50/2007]. A 1977 English book, Zen Shiatsu: How to Harmonize Yin and Yang for Better Health, is listed under Masunaga's name in library catalogues. Wataru Ohashi's co-authorship and the publisher are [uncertain: not verified].

Core idea of change, as each school states it (attributed, not fact). Within the tradition, shiatsu works on the flow of ki (qi) along meridians, "correcting imbalances, and maintaining and promoting health" [source: CNHC core curriculum; Cancer Research UK]. In Masunaga's account, the meridians are "human life itself", an imbalance "is not bad" in itself, and treatment addresses the hidden kyo rather than the loud jitsu [source: Masunaga, Shiatsu Journal 50/2007, translated from German]. The Namikoshi framing is anatomical and physiological [source: Wikipedia, citing Anderson 2008]. Meridians and ki are concepts of the tradition. A study found no conclusive support for electrically distinct meridians [source: Wikipedia, citing Ahn et al. 2008].

Evidence status. There is "no scientific evidence that shiatsu can cure or prevent any type of disease" [source: Cancer Research UK]. A 2011 systematic review (Robinson, Lorenc & Liao) found nine shiatsu studies of "insufficient quantity and quality". Acupressure had stronger evidence in some areas, such as some pain conditions, post-operative nausea and sleep in institutionalised older people [source: DOAJ and LSBU abstract]. The European Shiatsu Federation funded a cross-European cohort study (Long, University of Leeds, 2007). It surveyed 948 clients in Austria, Spain and the UK, and 633 completed all four questionnaires. Clients reported reduced tension or stress and musculoskeletal symptoms, frequent lifestyle changes and high satisfaction. The study had no comparison group, so it cannot show cause [source: Long 2007 final report; Tripp 2009]. In 2017, Australia removed shiatsu from private-health-insurance rebates after a 2015 government review found no clear evidence of effectiveness [source: Wikipedia, citing Baggoley 2015 and Paola 2017]. NICE does not recommend it [source: InformationNOW]. Shiatsu is not a treatment for any physical disease, including cancer.

2. Framework

Shiatsu does not use a staged protocol with fixed session counts. The published sources give a session structure and a training and regulatory framework. The phases below are the psychotherapist's path alongside a client's shiatsu [synthesis], with each school's own session structure inside Phase 4.

Who delivers it and how they are regulated.

Japan. Under Act No. 217 of 1947 (あん摩マツサージ指圧師、はり師、きゆう師等に関する法律), a non-physician who practises anma, massage or shiatsu as a business needs a licence: 「医師以外の者で、あん摩、マツサージ若しくは指圧…を業としようとする者は、…免許を受けなければならない。」 In short, practice as a business requires a licence. The Minister of Health, Labour and Welfare grants it after at least three years at an approved school and a pass in the national examination (Art. 2). Practitioners may not perform surgery or give drugs (Art. 4). They may not treat a dislocated or fractured area without a doctor's consent (Art. 5). Advertising is restricted (Art. 7), and confidentiality continues after they stop practising (Art. 7-2) [source: hourei.net, Act text]. The 1955 amendment (Act No. 161) has transitional provisions for people already practising shiatsu. The commonly cited 1964 amendment (Act No. 120) that added 指圧 to the law's title is [uncertain: title change not verified]. Namikoshi's own role in these milestones is [uncertain: not verified].
UK. No law protects the title. Registration is voluntary, with the Complementary and Natural Healthcare Council (CNHC), and most reputable practitioners belong to the Shiatsu Society UK [source: Cancer Research UK]. The CNHC core curriculum (April 2023) sets a minimum standard: three years of training, 1,000 hours of total qualification time including 500 guided learning hours, Level 4 (England and Wales), at least three case studies of six or more sessions each, 200 case notes and independent practical assessment. It covers anatomy, physiology and pathology, contraindications, consent, referral and record keeping [source: CNHC core curriculum]. Shiatsu Society membership grades and its code of ethics are [uncertain: not verified].
Europe. The European Shiatsu Federation brings national shiatsu societies together and commissioned the Long study. Eligible practitioners had to be on their national society's register [source: Long 2007; Tripp 2009]. ESF's current membership and standards are [uncertain: not verified].
Elsewhere. In Australia, unregistered health workers such as massage therapists fall under the National Code of Conduct for health care workers, enforced through state health complaints bodies [source: HaDSCO WA; AMT]. US arrangements (state massage boards, or shiatsu-specific credentials) are [uncertain: not verified]. Ask the practitioner which body they answer to.

Phases for the psychotherapist [synthesis unless tagged]:

Consider fit. The client asks about bodywork, or the formulation suggests that relaxation, body awareness or a safe experience of touch could help. Move on once the goal is clear and no medical red flag is open.
Screen and refer. Raise the medical cautions (below) and get medical clearance where needed. Help the client choose a registered practitioner, and agree consent to share information. Move on once a practitioner is chosen and the client knows how to stop a session.
Prepare for touch. This is essential for clients with trauma histories. Make a consent and stop-signal plan and practise saying what they want. Move on when the client can describe their plan and says they feel ready, not pushed.
Shiatsu course (delivered by the practitioner). The practitioner usually takes a history covering health, lifestyle, medical history, diet, sleep and emotional wellbeing, and may check with the GP. Treatment is on a futon, clothed, and lasts about an hour [source: Cancer Research UK]. A Zen-style practitioner assesses through palpation of hara, back and meridians, then works on kyo-jitsu [source: Masunaga 2007]. About three-quarters of clients in the ESF study got advice on posture, exercise or diet [source: Long 2007]. Neither school, in the sources cited, gives a set number of sessions. In the ESF cohort, most clients were long-term users still attending at six months [source: Long 2007].
Integration in psychotherapy. In your own sessions, process the body experiences, emotions and memories that come up. This runs alongside Phase 4.
Review. At agreed points, check the client's own goals, any side effects, how the relationship with the practitioner feels and whether to continue. Stop or pause if there are adverse effects, a boundary concern, or the client is going along with it while privately reluctant.

3. Guiding principles

Attribute the tradition's concepts. Ki, meridians, tsubo, kyo-jitsu and hara diagnosis belong to the tradition [source: CNHC; Masunaga 2007]. Practical meaning: say "in shiatsu theory…", never "your meridian is blocked".
Not a disease treatment. No evidence that it cures or prevents disease [source: Cancer Research UK]. Practical meaning: frame it around relaxation, body awareness and the client's own experience. It never replaces medical care.
Stay in your role. Mainstream codes (BACP 2018 and 2026, UKCP 2019, BPS, HCPC, APA, AAMFT) have no explicit touch clause. All of them prohibit sexual contact and require practice within competence and referral when appropriate [source: BACP 2018 and 2026; UKCP 2019; BPS 2009; HCPC 2023; APA; AAMFT 2015]. Practical meaning: refer to a shiatsu practitioner. Do not give shiatsu in a psychotherapy session unless you are separately trained and registered and your code allows touch. Body-psychotherapy codes (USABP, EABP) set explicit touch standards.
Consent before and during. USABP VIII.2 and VIII.5 require informed consent before touch and the client's right "to refuse or end any touch... at any time" [source: USABP]. Practical meaning: tell the client they can stop or change the touch at any point, including halfway through a technique, and rehearse how.
Never sexual. Sexual or genital touch is always inappropriate [source: USABP], and every code cited bans sexual contact. Practical meaning: shiatsu is given clothed. Any sexualised touch or remark is a boundary violation to report (Section 4).
Screen before first contact. Shiatsu needs a gentler approach with low platelets or osteoporosis. Some points are avoided in the first trimester of pregnancy, and treatment may be postponed with a fever [source: Cancer Research UK]. In Japan, fractures and dislocations need a doctor's consent [source: Act Art. 5]. Practical meaning: ask the client to tell the practitioner about these, and to get medical clearance where you are unsure.
Trauma-informed pacing [synthesis]. Hara palpation, lying on the floor, a practitioner leaning their weight in, and touch through clothing can all be activating. Practical meaning: plan positions, areas to leave out and a stop signal in advance.
Collaborate without merging roles. When a client receives similar services elsewhere, the therapist thinks through the implications and discusses them with the client [source: EABP 6.b]. Practical meaning: agree with the client what, if anything, is shared between you and the practitioner.
Treat negative reactions as information. In the ESF study, 12–22% of clients reported negative responses at each follow-up, and about 3% of the classified episodes were potentially adverse [source: Long 2007]. Practical meaning: ask about reactions after every shiatsu session. Do not accept "it's just detox" or "a healing reaction" without checking.
Respect cultural meaning [synthesis]. For Japanese clients or clients trained in East Asian medicine, shiatsu may carry family, cultural or professional meaning. Practical meaning: ask what it means to them before giving your own framing.

4. Intervention inventory

Part A describes what a shiatsu practitioner does, as the schools and sources publish it, so you can explain it to clients and prepare them. You do not perform these unless you are separately trained and registered as a shiatsu practitioner. Part B covers the psychotherapist's own interventions. All example language is illustrative.

Part A. Shiatsu components (delivered by the shiatsu practitioner)

A1. Consultation and case history

Purpose: to assess suitability, spot cautions and learn the client's goals.
Steps (as published): The practitioner asks about health, lifestyle, medical history, diet, sleep and emotional wellbeing, and may contact the GP [source: Cancer Research UK]. CNHC-standard training includes evaluation by looking, asking, listening and touch, and recognising when a client should seek help elsewhere [source: CNHC core curriculum]. Japanese licensees may not treat fractures or dislocations without a doctor's consent [source: Act Art. 5].
Example language (to prepare the client): "The practitioner will ask about your health, sleep and mood. It's fine to tell them only what you're comfortable sharing, and fine to mention your trauma history in just one sentence if you want them to know."
Watch for: a practitioner who skips the medical history, says they can diagnose or cure disease, or advises stopping prescribed treatment. These are reasons to reconsider the referral.

A2. Hara (abdominal) assessment

Purpose: in Zen shiatsu, the key to meridian diagnosis [source: Masunaga 2007]. Many practitioners begin by gently touching the abdomen to judge where attention is needed [source: Cancer Research UK].
Steps (as published): The practitioner palpates zones of the abdomen that Masunaga's charts link to the meridians. A sunken area that is firm at depth is read as kyo, and an elastic or raised area as jitsu. The back is read the same way [source: Masunaga 2007]. These readings are interpretations within the tradition.
Example language: "Many shiatsu practitioners start by gently feeling the belly area through your clothes. Some people find that very exposing. You can ask them to skip it or start somewhere else, like the back or shoulders."
Watch for: abdominal touch is a common trigger after sexual or medical trauma [synthesis]. Ask afterwards how it felt. If the client froze or went numb, plan to leave it out next time.

A3. Meridian and point pressure

Purpose: the main treatment. Namikoshi presents it in anatomical terms; Zen shiatsu presents it as working the meridians and tsubo to rebalance ki [source: Wikipedia citing Anderson 2008; CNHC].
Steps (as published): Pressure from thumbs, fingers and palms, and in many styles also elbows, knees or feet [source: Cancer Research UK; CNHC]. Masunaga describes sustained, steady pressure held in place, as when taking a pulse, rather than gliding along the line [source: Masunaga 2007]. CNHC training covers working with body weight and from the practitioner's own hara, and keeping continuous contact [source: CNHC core curriculum]. This guide gives no pressure levels or timings.
Example language: "The pressure is meant to stay comfortable. If it hurts or doesn't feel right, saying 'lighter' or 'stop there' is part of how it works, not rude."
Watch for: pain, bruising, or headaches and stiffness that last more than a few hours. Mild after-effects such as headache, muscle stiffness and tiredness usually pass within hours [source: Cancer Research UK]. Pressure on the neck carries a documented risk: a case of internal jugular vein thrombosis after neck shiatsu was reported (Wada et al. 2005) [source: Wikipedia; uncertain: the case report itself not verified].

A4. Two-handed (yin-yang) contact

Purpose: in the Iokai style, the practitioner uses two hands together to sense meridian flow between them. The aim is for the client to share that sensation [source: Masunaga 2007]. The "mother hand" and "supporting hand" terms used in many schools do not appear in the sources cited [uncertain].
Steps (as published): One hand stays as a steady, still contact while the other works along the meridian [source: Masunaga 2007; detail beyond this uncertain].
Example language: "You may notice one of their hands just resting while the other moves. If you'd rather know where they'll touch next, you can ask them to say it before they do."
Watch for: clients who dissociate when they can't predict the next touch [synthesis]. A request for a running commentary is reasonable.

A5. Meridian stretches and passive movement

Purpose: to bring a meridian to the surface so it can be read and treated [source: Masunaga 2007]. In general, shiatsu includes stretching [source: Cancer Research UK].
Steps (as published): The practitioner fixes one point as a fulcrum and stretches the limb so the meridian surfaces. They then read its kyo-jitsu [source: Masunaga 2007]. Positions include lying on the back, on the front, on the side and seated [source: CNHC]. The self-practice Makko-ho exercises often linked with Masunaga are not described in the sources cited [uncertain]. Self-exercises are not prescribed here.
Example language: "They may gently move or stretch your arms and legs. Being held in a position can feel restricting for some people, and you can ask to come out of it at any time."
Watch for: joint pain, and stretches near recent fractures, dislocations or osteoporosis (a gentler approach is needed) [source: Cancer Research UK; Act Art. 5]. Also watch for distress when the client feels restrained [synthesis].

A6. Advice and aftercare

Purpose: to support the session. In the ESF study, about three-quarters of clients got advice on posture, exercise or diet, and about four-fifths reported lifestyle changes at six months [source: Long 2007].
Steps (as published): The practitioner gives advice within their scope. CNHC training includes advising clients when shiatsu is not appropriate and helping them look at other options [source: CNHC].
Example language: "If they suggest changes to diet or exercise, bring them here and we can think about how they fit with the rest of your life and any medical advice you have."
Watch for: diet advice to clients with eating-disorder histories, and advice that conflicts with medical treatment [synthesis]. Liaise, with consent.

Part B. The psychotherapist's interventions

B1. Deciding when to suggest shiatsu

Purpose: to match the referral to the client's goals and stay honest about the evidence.
Steps [synthesis]: (1) Ask what the client hopes for. In the ESF cohort, common hopes were relaxation and stress relief, symptom relief, emotional support and greater body-mind awareness [source: Long 2007]. (2) Share the evidence status plainly: client-reported benefits, weak controlled evidence, no disease claims. (3) Check for contraindications (B2). (4) Weigh up whether touch fits the stage of therapy. Delay it when trauma symptoms are acute or the client tends to go along with others to please them.
Example language: "People often say shiatsu helps them relax and notice their body more. The research is thin, and it isn't a treatment for illness. Would that kind of experience fit what you're working on?"
Watch for: the client seeing shiatsu as a cure for a medical condition, wanting it to avoid emotional work, or agreeing because they think you want them to.

B2. Medical and safety screening

Purpose: to make sure the client and practitioner know about cautions before the first session.
Steps: Ask about, and suggest the client tells the practitioner about:
- low platelets or bleeding problems
- osteoporosis
- early pregnancy, when some points are avoided
- fever, when treatment may be postponed
- recent fractures or dislocations
- cancer
- heart disease
- epilepsy
[source: Cancer Research UK; InformationNOW; Act Art. 5] Sources disagree on how far these rule shiatsu out. InformationNOW says shiatsu should not be used with cancer, heart disease, epilepsy, osteoporosis or fractures. Cancer Research UK says shiatsu is generally safe and calls for a gentler approach for some conditions [uncertain: sources conflict]. Where any of these applies, recommend medical clearance. CNHC training also flags contagious, infectious, red-flag and notifiable conditions, and clients under 16 [source: CNHC]. Anticoagulant use is a [synthesis] caution, by analogy with other pressure-based massage.
Example language: "Before you book, could you check with your GP, given your osteoporosis? Then tell the practitioner about it at the start, so they can work more gently."
Watch for: a client who downplays conditions, or a practitioner who brushes cautions aside.

B3. Choosing a practitioner and setting up the referral

Purpose: to make sure the practitioner is trained and accountable.
Steps: (1) In Japan, look for the national あん摩マッサージ指圧師 licence [source: Act Art. 1–2]. In the UK, check CNHC registration or Shiatsu Society membership, and ask about years of training and practice [source: Cancer Research UK]. Elsewhere, ask which body sets their code and handles complaints. (2) Ask which style they practise, Namikoshi, Zen/Masunaga or another, so you can prepare the client. (3) Agree in writing what the client consents to share between you and the practitioner [synthesis; EABP 6.b]. (4) Take no referral fees [source: EABP 5.d].
Example language: "Ask them where they trained, whether they're on a register, and what they do if a client wants to stop. A good practitioner will be glad you asked."
Watch for: practitioners with no register or complaints route, those who promise cures, and those who discourage you and the client from talking.

B4. Preparing trauma-affected clients for touch

Purpose: to make the client's consent informed and active, and to lower the risk of re-traumatisation.
Steps [synthesis, drawing on USABP VIII]: (1) Walk through what a session looks like: clothed, on a floor futon, possibly starting at the abdomen, with pressure from hands, elbows or knees and with stretches [source: Cancer Research UK; CNHC]. (2) Map areas that are off limits and positions the client is comfortable with. Lying on the front or with someone kneeling over them may be hard. (3) Agree a stop word and a 'change' word. Rehearse saying them aloud in session. (4) Decide what, if anything, to tell the practitioner about trauma. (5) Plan grounding for after the session and how to get home. (6) Mention a chaperone or a familiar person nearby if that helps. Ask the practitioner whether this is possible [uncertain: shiatsu bodies' chaperone policies not verified].
Example language: "Let's practise. Say 'Can we stop for a moment?' in your normal voice. Now 'Not my belly, please.' How did that feel to say?"
Watch for: the client saying it's fine without engaging, signs of freezing during rehearsal, or a sense of owing the practitioner compliance. Readiness shows when the client can name their limits without apologising.

B5. Integrating body experience in psychotherapy

Purpose: to use what comes up in shiatsu as material for therapy. In the ESF study, clients described feeling energy moving, calm and balance [source: Long 2007]. About a third described deeper changes in outlook and body awareness [source: Tripp 2009].
Steps [synthesis]: (1) Ask open questions about what the client noticed in their body, emotions, images or memories. (2) Use the client's own words. If they use shiatsu terms like ki or kyo, explore what those mean to them without endorsing or dismissing them. (3) Link the experience to the treatment goals. (4) If a memory came up, work at the client's window of tolerance.
Example language: "When she worked on your shoulders and you felt tearful, what was that like? Is there anything familiar about that feeling?"
Watch for: clients treating the practitioner's interpretations as facts about their psyche. An example is "she said my kidney meridian holds fear". Gently separate the practitioner's framework from the client's own experience.

B6. Responding to after-effects and adverse effects

Purpose: to tell expected after-effects from adverse ones and act on them.
Steps: (1) Ask after each session about headache, stiffness, tiredness and mood. Mild effects that pass within hours are commonly reported [source: Cancer Research UK]. (2) In the ESF study, most negative responses were classed as transitional, which the authors linked to shiatsu theory. About 3% were potentially adverse [source: Long 2007]. A later commentary found that over half of clients reported at least one negative reaction, and it called for better client preparation [source: Tripp 2009]. (3) If symptoms persist, the client should contact the practitioner and the GP [source: Cancer Research UK; InformationNOW]. (4) Sudden neck, head or limb swelling, pain or neurological symptoms after neck work need urgent medical attention [synthesis; cf. Wada 2005 case, uncertain].
Example language: "A bit of tiredness after the first session is common. A headache that's still there tomorrow isn't something to just put up with. Let's get that checked."
Watch for: practitioners who call every reaction a 'healing crisis', and emotional dysregulation that lasts days.

B7. Recognising and reporting boundary violations

Purpose: to protect clients and support them in reporting.
Steps: (1) Name clear red flags: any touch of genitals or breasts, sexual remarks, being asked to undress (shiatsu is given clothed), continuing after being asked to stop, dating requests, secrecy, and pressure to buy more sessions or products [source: Cancer Research UK on clothing; USABP on sexual touch; synthesis]. (2) Believe the client and help them get safe. (3) Help them report: in Japan, to the prefectural health authorities [uncertain: route not verified]. In the UK, to CNHC if the practitioner is registered, or to the Shiatsu Society [uncertain: complaint procedures not verified]. In Australia, to the state health complaints entity under the National Code [source: HaDSCO WA]. Report to the police in every case of sexual assault. (4) Follow your own safeguarding duties.
Example language: "What you're describing isn't part of shiatsu, and it wasn't your fault. Would you like to look at how to report it, together?"
Watch for: self-blame, minimising ("maybe it was a technique"), and the client staying in contact out of obligation.

B8. Cultural meaning and teaching authority

Purpose: to respect shiatsu as a living Japanese tradition with licensed and lineage-based teaching.
Steps: (1) Ask what shiatsu means to the client. (2) Recognise who holds teaching authority: in Japan, licensed schools under national law, such as Namikoshi's Japan Shiatsu College. For Zen shiatsu, the Iokai lineage, plus national societies such as the Shiatsu Society UK and the ESF member societies [source: Act; best-shingaku; Wikipedia; Long 2007]. (3) Do not use meridian language yourself as if it were clinical fact.
Example language: "Your grandmother had shiatsu in Osaka. What does it mean to you to try it now?"
Watch for: your own assumptions, either exoticising the practice or dismissing it [synthesis].

B9. If you are also a trained shiatsu practitioner

Purpose: to handle dual qualification safely.
Steps: No mainstream psychotherapy code (BACP, UKCP, BPS, HCPC, APA, AAMFT) has an explicit touch clause. All require competence, clear boundaries and avoiding harmful dual relationships [source: BACP 2018; UKCP 2019; BPS 2009; HCPC 2023; APA; AAMFT 2015]. The EABP code covers body techniques, including massage, in body psychotherapy. It requires that clients are "informed beforehand" and that communication is explicit [source: EABP]. USABP requires documented assessment of whether touch suits each client, informed consent (preferably written) and ongoing checks of consent [source: USABP]. [synthesis] Unless your code and training explicitly cover combined work, keep the two roles separate: refer the client to another practitioner rather than giving them shiatsu yourself.
Example language: "I'm trained in shiatsu as well, but I don't mix it with our therapy. If you'd like to try it, I'll suggest some colleagues."
Watch for: a client asking you to switch roles, which may signal a wish for closeness to explore, not act on [synthesis].

5. Handling problems

Most of this section is [synthesis]. The shiatsu sources say little about psychotherapy-side problems. Where a point rests on a source, the source is tagged.

Client wants shiatsu to fix a medical condition. Restate that there is no evidence it cures or prevents disease [source: Cancer Research UK] and that it does not replace medical care. Offer it, if at all, for relaxation or body awareness alongside medical treatment. Say (illustrative): "It might help you feel more relaxed while you go through treatment, but it won't treat the illness itself."
Client agrees to touch without really wanting it. Slow the referral down. Explore what saying no would mean for them, and make it clear that not going is a full and valid choice. Say: "You don't have to try this for me or for anyone else. What would it be like to decide not to?"
Overwhelm or flashback during or after a session. Help the client ground themselves in your next session. Revisit their consent plan: drop the triggering areas or positions such as the abdomen, lying on the front, or being held in a stretch, or pause shiatsu altogether. If the practitioner went on after a stop request, treat it as a boundary violation (B7). Say: "Let's look at exactly when it changed for you, so we can protect that next time or decide to stop."
Practitioner says a reaction is "part of the healing". Transitional reactions are part of shiatsu theory, and the ESF study classed most negative responses that way [source: Long 2007]. Persistent or worsening symptoms still need checking with the practitioner and GP [source: Cancer Research UK]. Help the client trust their own judgement over the explanation.
Conflicting explanations (meridians versus psychology). The client may bring meridian or five-element meanings for their feelings. Explore them as the client's chosen language without endorsing them as fact. Keep the psychological formulation your own. Say: "In shiatsu theory that's how they'd see it. What do you make of it yourself?"
Non-adherence (sessions dropped). Ask what got in the way: cost, which is often £30–£60 an hour in the UK [source: Cancer Research UK], discomfort, or the relationship with the practitioner. Stopping is fine. Some UK cancer centres offer free sessions [source: Cancer Research UK].
Dependency on the practitioner or more talk-therapy content in shiatsu than in therapy. The client may start bringing emotional material to the practitioner instead of to therapy. Name the split gently and agree where each kind of work happens. The EABP code advises careful discussion of parallel services [source: EABP 6.b]. Say: "It sounds like a lot comes up on the futon. How would it be to bring some of that here too?"
Rupture with you over the referral. The client may feel you are passing them on or avoiding their body. Acknowledge it, explain why you are referring (role and competence), and keep the door open.
Client asks you to give shiatsu. Decline and explain why: your role, your code and your competence [source: UKCP 2019 item 23; BACP 2018 para 13]. Explore what the wish means within the relationship (B9).
Modality-specific risks.
- Neck work: one case of internal jugular vein thrombosis after neck shiatsu has been reported [source: Wikipedia citing Wada 2005; uncertain]. Clients with vascular risk factors should get medical advice first.
- Pregnancy: some points are avoided in early pregnancy [source: Cancer Research UK].
- Bones and joints: fractures and dislocations need a doctor's consent in Japan [source: Act Art. 5], and osteoporosis needs a gentler approach.
- Shiatsu-type massage machines have been linked to injury [source: Wikipedia; uncertain]. Do not treat them as equivalent to practitioner shiatsu.
Style confusion. Namikoshi practitioners frame their work anatomically. Zen practitioners use kyo-jitsu and meridian diagnosis. A client who left one style dissatisfied may suit the other, or neither. Ask which style they had before drawing conclusions.
Children and adolescents. CNHC training lists under-16s as needing special consideration [source: CNHC]. Get the young person's assent and parental consent, with a parent or chaperone present, and follow safeguarding procedures.
Gaps in the sources. These were not verified: Namikoshi's own published technique and any formal sequence, the 1955 and 1964 recognition milestones, the Shiatsu Society UK and ESF codes and complaint procedures, and Masunaga's Makko-ho exercises. Ask the practitioner and their professional body for these details.

Sources

Web sources

Professional codes and complaint routes (touch, sexual contact, referral)

Books and papers cited through the pages above (details not verified)

Masunaga, S. (1977). Zen Shiatsu: How to Harmonize Yin and Yang for Better Health. Listed in library catalogues. Co-author (Ohashi) and publisher [uncertain].
Anderson, 2008; Jarmey & Mojay, 1991; Ahn et al., 2008, Bioelectromagnetics 29(4); Wada, Yanagihara & Nishimura, 2005, J Neurol Neurosurg Psychiatry 76(1); Baggoley, 2015, Australian Government review of the natural therapies rebate; all cited via Wikipedia [uncertain].