www.thebodyworker.com

Archive for Ethics

Massage Politics

June 24, 2008 Julie Onofrio Ethics, Licensing and Legislation

One of the biggest controversies in the massage profession has to do with the licensing and regulation of massage therapy. There are 38 states in the US that require massage therapists to have some type of licensing. Each state differs in the amount of education, classes and definitions of massage therapy which makes it very confusing to understand. The non-licensed states also have varying requirement to practice massage with the biggest problem in CA where each city has different requirements.

The groups that advocate licensing state that the reasons for wanting licensing are to protect the public from harm, create more professional standards of education, reduce the number of prostitutes doing massage to name a few. The thing is that there is no proof that massage has caused significant harm to people. Keith Grant has done an initial survey of medline on the cases of harm that are done to massage clients. How much harm can be done in doing massage? What is the definition of harm? Is it harmful to have a massage therapist who says they are doing deep tissue massage when it is really swedish massage? Is it harmful when a client leaves feeling more sore than when they came in? Will any amount of education really influence the massage therapists skills and reduce the ability to do harm?

If there were a high degree of harm being done, wouldn’t our liability insurance rates reflect that? And how much harm do over the counter drugs do? I just recently had a friend who had excruciating back and abdominal pain for over a year and it turns out it was an over the counter drug causing it. Is that harmful?

What list of side effects could be created to inform the public and teach the public to take responsibility for what happens in their massage?

The number of hours of education varies greatly as well as the topics of courses. I for one started in 1987 doing massage after having 250 hours of massage school. I was the last year of students to become a massage therapist at that number of hours. The number of hours of training was going up to 500 hours in a few months and for no reason at all as far as I could see – no testing to see if it was needed… no research…no case studies, no statistics that showed that having more education would help create a more successful massage therapist. The one thing I did notice was that once they did raise the number of hours, the massage schools increased their hours of training to exceed that 500 hours so that they could get more grant and loan funding for students. I would love to see if the number of students/graduates jumped at that exact time! The thing is that we have no information on what it does really take to be a successful massage therapist. It is more than just doing a good massage. You also have to be a business person. But massage can be learned in a basic 100 hour massage class. Keith Grant also has some information on that topic in his white paper “Issues in Massage Governance” (pdf). He also noticed the same coincidental increase in the number of hours and the number of grants/loans. He also talks about how people learn and sites that people learn better in smaller training programs and the preferred method is apprenticeship programs. There are a few states that do allow apprenticeship programs to be counted as massage training – WA State being one of them. It was actually the whole reason I started this website -www.thebodyworker.com but the thing is that you can only teach one student at a time unless you want to make it into a formal school, which doesn’t make it profitable.

This is the only information that I have seen that gives any insight into the issues that we are dealing with. If there are some other studies, information, proof that more hours of education are needed to be a successful massage therapist then I would love to see it.

CA also has the highest number of massage therapists despite them having this licensing problem. I think that most can become a massage therapist with 100 or 250 hours of training – correct me if I am wrong. So is it the number of hours of training that make a successful massage therapist?

The thing is that when people hear that after taking 1000 hour training classes I think that they somehow think it to mean that they didn’t need to take that many hours or that it is implied that they aren’t knowledgable or that more training is not beneficial. It could be beneficial to people who take it but it is not needed to be a successful massage therapist – that is all that it is saying.

The idea that massage therapists need all this medical training etc is really not true. It doesn’t mean that it could help to have extra classes and training. It does not mean that more training can give you more confidence and skills but they are just not needed to do a basic relaxation massage which is also very therapeutic. After 20 years of doing massage and learning structural integration, triggerpoint therapy and many other things I actually am going back to studying the affects of touch on healing. I once thought as an overzealous massage student that if everyone got a massage once a week (now I would say 3 times a week!) there would be world peace and now I would add – a great reduction in the number of diseases and health conditions that are on the rise.

So I actually don’t care much about licensing these days anymore despite this long post. I just write to hopefully inform someone and to inspire others to seek the truth. I am more than open to hearing any more on this topic, but quite frankly – I just want to do massage! (and write about it!) I sometimes get tweaked and think I should join AMTA or get ABMP more involved especially when I think about the state of insurance billing for massage therapists here in WA State – which talk about a mess! That’s a whole other category here.

So do you think you could do a really great massage just having 100 hours of training just on doing massage? I have lots of friends who have that number of hours because it used to be that number a long time ago. They are all still in business but it seems the more recent grads with 1000 hours can’t seem to make it. What does it take to be a successful massage therapist? Is it the number of hours of training? Is it some secret method? Is it just about the person and who they are and what they want in their lives?

6 comments

The need for Male Massage Therapists

May 14, 2008 Julie Onofrio Become a Massage Therapist, Ethics, News

The massage profession is predominately made up of women. ABMP reports that close to 83 percent are women. I have written about this topic before and there always seems to be more to be said about this. We need more men to be massage therapists!

Men are often intimidated in choosing a massage career. There are stories of men being discriminated against at spas or clinics with receptionists first asking if the caller wants a female or male massage therapist. The stigma is that women won’t want a male because they are intimidated by men or may have a past issue with men and they are untrusting of men. Men don’t want to be massaged by men thinking that the male massage therapist must be gay or that they will be thought of in less then favorable ways if they go to a male massage therapist. So who is left to go to a male massage therapist?

I for one am in a phase of only going to male massage therapists right now. The thing like the best is that men don’t seem to get caught up as much in some of the boundary issues that women do. Women seem to want to chat about everything and they want to offer all of their suggestions for healing or eating right or whatever it is when I just want a massage. I guess I have had male massage therapists talk the whole time too but I seem to find more male massage therapists who are just there to do the massage.

Working with a male massage therapist also helps teach us that males can be nurturing which can be good for either sex- female or male.

I have had males calling seeking male massage therapists (and not for a gay male exchange). Men have been hurt by women and men too so that a male working with a male massage therapist can receive the healing around gender issues that they need too.

Share you stories about working with male massage therapists by posting here. Posting on blogs is also a good way to get back links to your website which in turn helps you get a better Page Rank with Google.

What other issues are there in working with male massage therapists? How can we support men in choosing a career in massage? What do men need to know before choosing this career?

Medical Massage or Not

May 7, 2008 Julie Onofrio Ethics, Licensing and Legislation, News

One of my pet peeves in the massage profession has been this whole idea that medical massage is the future of the massage profession and that the massage profession should get involved with working with doctors and insurance companies as contracted providers. I am referring to working with HMO’s and PPO’s as a regular contracted provider and also some auto insurance companies who have joined networks. Medical Massage is not being defined by the massage profession itself so the insurance companies are doing it for us. Being in WA State where we are allowed to become contracted providers with insurance companies, I have been privileged to witness the demise of insurance billing in a few short years. This is what is happening here in WA and some reasons why we need to think twice about wanting to work with insurance companies.

The insurance companies are constantly reducing the allowable fee (what they pay you and that you accept when under contract with insurance companies.) When I first started in about 2000 accepting insurance one company paid me about $90 an hour which was a very acceptable rate. Within a few years they reduced that rate to less than $70 and it continued to be that same rate until this year when they gave us a $.40 raise – yes that is forty cents when the price of gas is sure to go over $4.00 a gallon.
The insurance companies are also constantly reducing their benefits in their policies with people. For example – one company who used to allow 45 sessions of massage and PT combined a year now only allows 14 sessions a year.
The insurance companies are constantly making it harder to get paid. One company in particular will ask that we prove medical necessity after 4-6 sessions of massage and then deny any further treatment no matter what it seems.
The insurance companies set the allowable fees and usually send out a rate chart in the beginning of the year or when you first contract with them. Although it hasn’t happened to me yet as a massage therapist, I have heard from a few chiropractors and an acupuncturist that they change their mind in the middle of the year and say they are paying too much and reduce the rates and MAKE YOU PAY BACK THE DIFFERENCE – yes I am yelling- and there is nothing that can be done except to pay them back or they will take it out of future payments. I do know of one Naturopath who almost went out of business because of it.
Out of network providers may often get paid more than in network providers- yes this is a fact too. There is one company doing just that. If you are out of network they only pay a percentage of the bill usually, but they pay contracted providers so poorly that even the percentage of the full bill which usually is about $132 (UCR) works out to be more than they pay contracted providers
One such health network includes a list of auto insurance companies who are using provider networks and rules to pay for services rendered. This means that you have to accept a reduced rate of pay.
Most of the companies have not increased their allowable fees since I started with them in 2000. So no raise for a contracted provider -not even to reflect a cost of living increase.
Insurance companies are also creating educational requirements for credentialing meaning they are saying what training and education is required to become a member with them. It doesn’t matter that we are licensed by the State Board of Health. The insurance profession is defining the massage profession.
Affinity networks are discount networks that some massage therapists unknowingly join thinking that they will get more clients not understanding that they are also taking a big cut in fees.

So does that make you still want to join a provider network and be able to bill insurance companies for your massage services?

See also the Insurance Billing Section on www.thebodyworker.com

2005 Guest editorial in Massage Magazine

Issues and Ethics in Billing Insurance Companies

3 comments

Seeds of Compassion

April 14, 2008 Julie Onofrio Ethics, News, The Wealthy Massage Therapist

The Dali Lama was just in town for the weekend promoting what he calls seeds of compassion. There were about 5 days of talks to mainly kids of all ages on compassion and how to be more compassionate toward others. I didn’t get to go to any of the events but heard him speak on TV and through his webcasts which you can find at seedsofcompassion.org.

One of the most interesting things he said was that more women should be leaders because compassion comes easier for them than it does for men because men are so caught up in their aggressive tendencies and egos! He also talked about how nothing can come of war and that talking is needed to end the differences between people. He said something about that the leaders of the world should come together and spend a few weeks on vacations together with their families so that they could see that we are all humans.

Compassion is such an interesting and complex subject. A few years ago I studied and read all that I came across on compassion – books and articles online.

What does it mean to be compassionate? Compassion is the feeling of wanting to relieve the pain and suffering and others. It goes a step beyond empathy which is feeling the feelings of another and acknowledging them in another. With compassion we move to make the other feel differently. Compassion requires that we move outside of ourselves and forget about ourselves. That requires that we be strong enough inside of ourselves to do that. If we do that and sacrifice our needs being met over another when we aren’t strong enough inside, it can end up in compassion fatigue (burnout.)

The first thing in being kind to another lies in learning to be kind to ourselves. In learning to serve others, we will often be confronted by our own suffering. It provides for many opportunities for growth and understanding. Helping others will reveal where we ourselves need helping and can lead to the path of healing.

When we first start to act compassionately, it usually is to fill some of our own needs for attention, recognition and approval. We seek what we didn’t get early in life and it is usually unconsciously. We believed those stories we were told and that we told ourself about how we were not good enough or smart enough or pretty enough until we didn’t know the difference between the truth and what is real. We developed our egos to make us feel better about ourselves when our insides were suffering and wanting the world and our lives to be different. The stories we tell ourselves are revealed when we move to help others compassionately. We feel that we can never do enough or do the right thing. We are led into our own suffering to show us the place inside us that need healing. Taking the path can lead us to authentic compassion or egoless compassion where we can come to a place of just giving to receive and to the place where all giving is receiving.

In Oprah’s recent new show “The Big Give” one of the things that keeps coming up is that when the contestants go to give away all the money they often fail to find out what the family or organization is really needing and they give what they think would be fun or nice to give. They are giving what makes them feel best rather than what others really need. Like one guy gave a party to a family that cost $500 when the family could hardly pay the rent. It lasted for an afternoon, but the $500 would have paid the bills to help reduce the stress of the family. Some of the most memorable gifts were just gifts of time and small gifts of appreciation.

When we can keep our own needs to give in check and find out what people truly need by listening to them and their stories we find authentic compassion. As we learn to open ourselves to our own suffering and feel our own pain we open ourselves more to be present with others in their suffering thereby witnessing the pain which makes it go away. I know it seems contradictory. I have been trying to fix clients for the better part of 20 years of being in practice as a massage therapist. Once I was able to go beyond my own needs for fixing which were appreciation and a need for connection, I could see that all the scientific solutions for all of the techniques I have learned and applied suddenly laced any real importance other than just being able to have something to do with the clients. When I could see beneath the surface and acknowledge my own feelings that were underneath the need to help and fix, I could be still enough to see that clients really had their own power to heal and if given the chance to feel their own feelings and make contact with their true essence a deeper healing could occur. The techniques became just a way to help people feel. The techniques became the path for uncovering the seed of compassion that were the real key to health and healing.

No comments

Massage Business -Creating Policies and Procedures

March 10, 2008 Julie Onofrio Ethics, Peer Supervision, Start Your Massage Business, The Wealthy Massage Therapist

As a massage therapist, creating a solid framework for you business is like creating a solid foundation for a building. The clearer and deeper you go, the taller and larger the building you can build.

So many massage therapists avoid creating policies like cancellation policies, late fees, no show policies and when they do they have a difficult time enforcing them.

By creating these policies it will let your client become more informed about who you are and what you do. They can then decide if you are a good match for them to work with. It also gives you the opportunity to choose who you want to work with and create your ideal massage practice. I struggled with these things too for years as a massage therapist thinking it was what I needed to do to get and keep clients. I thought that by not charging for missed appointments or working longer on people when they are late for an appointment that I was making an extra effort for them to like me and keep coming as a client. I thought I needed to take everyone as a client regardless of whether or not they fit in with my ideal client. In doing that for more than 15 years, I can now see that it was part of the causes for my burnout in the mid 90′s. Giving away your time, money and energy is just downright draining. Period. You may think it is doing the client a favor and helping them more.

I wrote about this previously and mentioned a readers poll done by Massage Magazine last year about their cancellation policies and the ways they enforce their cancellation policies. There is of course such a wide variety of ways and answers.

The thing is to find out what works best for you in supporting you as a business owner and as a person. On one hand you need to make money to pay the bills. Since the number of clients that you can see in one day is limited and having just one client not show up or cancel at the last minute can effect your income significantly. Enforcing the policy sometimes and not on others can be confusing to the clients. As Dr Phil says – “We teach people how to treat us.

While things do happen to people – getting stuck in traffic, sick kids, sick themselves, issues at work – who is responsible for the clients actions? Them or you?

Setting strict cancellation policies may end the relationship. The question is do you really want someone as a client who does not respect you or your time?

Creating well thought out policies can help you create a stronger massage practice.

-What is your policy for when someone cancels with less than 24 or even 48 hours?

- What is your policy for working on someone who arrives late to their appointment? Do you work longer if you have the time? Or do you stay to the alloted time frame?

-What do you do when someone just does not show up period. They just forgot for whatever reason. Then when you call them, they are not apologetic but blame you for not calling to remind them or say they don’t want to pay for something that they aren’t receiving?

- Do you have a cancellation policy that is clearly written and placed on your website and intake form? Do you verbally state your cancellation policy?

There are a variety of ways to handle these situations:

Charge a minimum fee like $35 or half your session fee for a no show.
Charge your whole session fee for a missed appointment.
Choose to work on someone who is late for the full appointment time if you have the time.
Give people one session to forget and then remind them of the policy and charge them for any further missed appointments.
Don’t charge anything or say anything and you just eat the cost for the lost time and energy. (How does that one feel?!)
Allow for extra-ordinary circumstances such as sickness, deaths in the family, real emergencies.

I also just did a quick search for ‘massage cancellation policies and found a variety of ways that people are communicating their policies some of which are very interesting with one person even apologizing for having to enforce the policy.

Here are some examples that I just copied off some websites ( I know- don’t get upset.)

Everyone’s time is valuable, that’s why we have to follow a few simple rules.

In today’s hectic world unplanned issues come up for all of us. We recognize this fact, but we respectfully request that you cancel your scheduled appointment by phone or e-mail a minimum of 24 hours in advance. That way the open slot can be filled with someone needing an appointment.

Failing two scheduled appointments in a row or three appointments within six months will result in a scheduling hold for Massage Appointments being placed on your account. This means you will not be able to schedule appointments with the Massage Therapy department.

You can also just do a search yourself and use some of the examples you find to create your own policy. The most important thing to think about is what you need to create a solid massage business.
I guess I am always amazed when people think they won’t have to pay for a missed appointment or have any obligation what so ever for their commitment (which just happened to me only for the second time in 20 years which is why I am writing about this again!) I think that people do feel bad for missing appointments but it may just be too hard to admit that they do. The feeling will overwhelm them and move them into a defense mode – blaming you, blaming traffic, blaming their boss rather than accepting responsibility. Most doctors have cancellation policies. If you book a flight and miss the flight you have to pay a large fee usually. If you get tickets to a symphony and miss it or are late, you don’t get reimbursed.

While creating these polices will be a very personal thing and enforcing them another just keep in mind that what you do is also affecting the massage profession as a whole. Letting people get away with no shows, late cancellations and late arrivals is teaching people how to treat us (massage therapists) as a whole. What policy do you need in place to create a successful and rewarding massage practice and profession?

2 comments

« Older Entries Recent Entries »