Ethics classes used to seem like the most boring part of being a massage therapist but studying ethics now seems like the only thing we should have to do as a massage therapist.  The techniques don’t really matter much if you don’t have clear boundaries and relationships with clients.

Ethics is just about relationships.  Relationships are the core of building a successful massage business or being successful in your massage job.  Studying ethics will help you if you are male and in this female dominated profession helping you to understand your role.   Women can benefit from studying ethics to help them deal with the many challenges of working on men (yes the dreaded E!) .

Ethics is just the process of uncovering your values and learning about relationships and how your work as a massage therapist can influence those relationships.   The clients that fall in love with you and want to marry you, the people who want to always get a discount or will hate it when you raise your rates.

People who are under stress and in pain and are half naked underneath a sheet are vulnerable.  As a massage therapist it is your responsibility to understand your role and understand where they are coming from or at least be able to not interfere in their lives.   I remember Oprah saying once on TV that she just wished massage therapists would shut up!

Ethics requires rational thought about what it is that you are doing or what is happening in your massage world.  Many may first think that they know what to do when a client asks them out on a date and may think there is no harm in dating clients or even just being friends with clients.  Educating massage therapists as to what happens in the therapeutic relationship can help them make more informed decisions about their actions.

It isn’t about being right or wrong.  It is about making a decision that supports you and your massage business.  There is also a legal side to being a massage therapist and working within your scope of practice.  What is legal is not always ethical and what is ethical is not always legal.  Ethics is about striving to be the best you can be and about treating people decently and respectfully.

Taking massage ethics classes is the most important thing you can do for yourself and the massage profession.

Related posts:

1. Exploring Ethics
2. Massage Ethics
3. Code of Ethics

The body stores memories of feelings in it’s cells.  It starts at an early age when we hold back our feelings and emotions.  It is often taught that it is not good to have feelings and emotions.  People will buck up and keep their feelings inside. Touch has a way of allowing these emotions to come to the surface.  As massage therapists it is out of our scope of practice to deal with the emotions.  We of course have to learn how to deal with them when they do come up or it could cause further problems.

Emotions can be anything from anger, sadness, grief, panic, anxiety, frustration and even laughter and joy.  It can be a simple sigh of relief or a deep breath.  It can be heat or cold in an area of the body.   It can be people who ask for extreme deep tissue sessions because they actually can not feel and are numb both physically and emotionally.   People may say they have a  high tolerance for pain and won’t feel pain or will ignore it for a long time before doing anything about it. Anyone can experience emotions on the massage table.  Elliot Greene in his book The Psychology of the Body (Lww Massage Therapy & Bodywork Educational Series)
says that people who suffer from chronic pain are also somewhat more likely to experience emotional release.  When the massage therapy begins to disrupt the underlying physical patterns behind the pain, then emotional patterns related to the chronic physical pattern may surface.”

Sexual, physical and emotional trauma at an early age or in any stage of life for that matter can leave it’s mark on a persons body and emotions.   People with a history of  abuse of any kind have a high likelihood of having body armor.  It includes people who have been traumatized in war, natural disasters and things like car accidents or crime victims.  Armoring in the body is a natural result of trauma.  It is defined as chronic patterns of involuntary tension in the body that dampen or block emotional expression, alter perception of both the outer and inner psychological world, diminish or eliminate kinesthetic awareness and other sensations and restrict the range of motion according to Greene in the “Psychology of the Body”.   The war vet will think that everyone is following them and be sent into fight or flight when someone touches their neck if they sat in a trench for awhile waiting for the enemy to come from behind.   People in car accidents that experience intense physical impact while they turn their head may years later recall the sound of the crash every time they turn their head in the same way.  Stress can build up so much in tense muscles that just the lightest touch can bring tears to the eyes of many.

To be able to work with people who are undergoing emotional release requires that you be able to be present with the client.  This basically is staying in a non-judgmental open state and not ask questions or direct peoples conversation.  It is a state where you totally allow the experience to unfold and focus on the client without letting your emotions and agendas (if any) to get in the way.  To do that requires that you do your own personal emotional work either through massage and bodywork or with a skilled therapist.  Supervision can also help you in learning to deal with emotional releases on the massage table.

The thing to know about working with people is that the goal is not to try to get an emotional release.   The feelings can actually be released without having emotions come forth.  Because it is inevitable that a client will have an emotional release at some time on your massage table it is important to get further training in this area to be able to support the client appropriately.

Online Class:
Body Psychology

Recommended Reading:
The Psychology of the Body (Lww Massage Therapy & Bodywork Educational Series)
-Elliot Greene

Somato Emotional Release
by John Upledger, DO

Related posts:

1. Effective Massage Therapists Master Their Emotions
2. Psychology of the Body
3. Working with a Psychologist doing massage

Many professional associations have a so called “Code of Ethics” which members are supposed to abide by.  The thing is that they are so general in nature that they can be widely interpreted.  Here are some sample code of ethics statements of professional associations:

The AMTA Code of Ethics:

This Code of Ethics is a summary statement of the standards by which massage therapists agree to conduct their practices and is a declaration of the general principles of acceptable, ethical, professional behavior.

Massage therapists shall:

1. Demonstrate commitment to provide the highest quality massage therapy/bodywork to those who seek their professional service.

2. Acknowledge the inherent worth and individuality of each person by  not discriminating or behaving in any prejudicial manner with clients and/or colleagues.

3. Demonstrate professional excellence through regular self-assessment of strengths, limitations, and effectiveness by continued education and training.

4. Acknowledge the confidential nature of the professional relationship with clients and respect each client’s right to privacy.

5. Conduct all business and professional activities within their scope of practice, the law of the land, and project a professional image.

6. Refrain from engaging in any sexual conduct or sexual activities involving their clients.

7. Accept responsibility to do no harm to the physical, mental and emotional well-being of self, clients, and associates.

The ABMP Code of Ethics is a little longer.

Client Relationships

• I shall endeavor to serve the best interests of my clients at all times and to provide the highest quality service possible.
• I shall maintain clear and honest communications with my clients and shall keep client communications confidential.
• I shall acknowledge the limitations of my skills and, when necessary, refer clients to the appropriate qualified health care professional.
• I shall in no way instigate or tolerate any kind of sexual advance while acting in the capacity of a massage, bodywork, somatic therapy or esthetic practitioner.

Professionalism

• I shall maintain the highest standards of professional conduct, providing services in an ethical and professional manner in relation to my clientele, business associates, health care professionals, and the general public.
• I shall respect the rights of all ethical practitioners and will cooperate with all health care professionals in a friendly and professional manner.
• I shall refrain from the use of any mind-altering drugs, alcohol, or intoxicants prior to or during professional sessions.
• I shall always dress in a professional manner, proper dress being defined as attire suitable and consistent with accepted business and professional practice.
• I shall not be affiliated with or employed by any business that utilizes any form of sexual suggestiveness or explicit sexuality in its advertising or promotion of services, or in the actual practice of its services.

Scope of Practice / Appropriate Techniques

• I shall provide services within the scope of the ABMP definition of massage, bodywork, somatic therapies and skin care, and the limits of my training. I will not employ those massage, bodywork or skin care techniques for which I have not had adequate training and shall represent my education, training, qualifications and abilities honestly.
• I shall be conscious of the intent of the services that I am providing and shall be aware of and practice good judgment regarding the application of massage, bodywork or somatic techniques utilized.
• I shall not perform manipulations or adjustments of the human skeletal structure, diagnose, prescribe or provide any other service, procedure or therapy which requires a license to practice chiropractic, osteopathy, physical therapy, podiatry, orthopedics, psychotherapy, acupuncture, dermatology, cosmetology, or any other profession or branch of medicine unless specifically licensed to do so.
• I shall be thoroughly educated and understand the physiological effects of the specific massage, bodywork, somatic or skin care techniques utilized in order to determine whether such application is contraindicated and/or to determine the most beneficial techniques to apply to a given individual. I shall not apply massage, bodywork, somatic or skin care techniques in those cases where they may be contraindicated without a written referral from the client’s primary care provider.

Image / Advertising Claims

• I shall strive to project a professional image for myself, my business or place of employment, and the profession in general.
• I shall actively participate in educating the public regarding the actual benefits of massage, bodywork, somatic therapies and skin care.
• I shall practice honesty in advertising, promote my services ethically and in good taste, and practice and/or advertise only those techniques for which I have received adequate training and/or certification. I shall not make false claims regarding the potential benefits of the techniques rendered.

The basics of ethics is uncovering your own beliefs and values and understanding what motivates your actions and thoughts.  In doing so you can create a massage business or find your ideal massage job that is a clear reflection of you and your values.   It is an ongoing process because most of our values are ‘inherited’ from our early upbringing and not really chosen by us.  They are taught to us by our parents and in school.

Massage clients also come to a massage therapist seeking help.  The dynamics of the helping relationship recreate the dynamics of the parent/child relationship.  It is important to be clear about what is what to become an effective massage therapist.  Situations will arise on a daily basis as a massage therapist that will constantly challenge your values and your core beliefs about yourself.  To help you unravel the underlying needs and perceptions participating in peer supervision groups or individual supervision classes can help you to do that.

Since we need to take ethics to meet continuing education requirements and to build successful careers finding the best massage ethics classes isn’t always so easy.  There are a handful of online classes that you can read some material and take a test.  While this fulfills the requirements for continuing ed having a live interactive class  or participating in supervision will help you in creating your own code of ethics and help you in learning to live by your values and create meaningful therapeutic relationships with you clients.  It is the therapeutic relationship that will help you build your career.

I have started an small directory of the online massage ethics classes where you can post your class and also write a review on the class and rate it.   There is also some more information on massage ethics that I have started and will be adding too on my www.massage-career-guides.com website.  I also have some earlier writings on ethics in the massage profession on this site and in my blog posts on ethics for massage therapists.

Online Ethics Classes
The 2-Hour Ethics Course: Professional Roles and Boundaries

The 6-Hour Ethics Course: Ethics from the Dalai Lama

The 4-Hour Ethics Course: Legal and Ethical Issues

Related posts:

1. Massage Ethics Classes
2. Exploring Ethics
3. Code of Ethics

The best thing you can do to take care of yourself is to become more conscious of your unmet needs and repressed/suppressed feelings so that you can be more present in your massage sessions for your clients. That is what they pay you for really. Your unmet needs and old emotions are what get projected onto others and onto clients in the form of counter-transference. I have written about countertransference before here.

Your unmet needs and old emotions are projected into your practice, your money issues and your personal relationships.  Self  care that addresses these issues and helps you to become more aware of these issues can often reduce the physical stress of doing massage.  The more you take care of yourself in that way, the more confident you become in asking for what you need and creating boundaries to take care of yourself in the client/massage therapist relationship.

Being financially responsible is one such method of self care which usually is not mentioned in self care classes/articles.   Having the money that you need to live and run your business is the highest form of self care possible. The other way to take care of yourself is taking care of your personal needs for appreciation, love and nurturing. When you combine the two things you won’t have to worry about body mechanics or how hard you work on clients or working more than the agreed upon time.

Helping has a way of bringing up our unmet needs. It shows up in counter-transference. The reasons why massage therapists want to help others is usually filled with unconscious unmet needs and old feelings. Countertransference influences the client interactions and the healing process sometimes hindering it. When you are in a state of countertransference , projecting your old issues and feelings onto a client it can cause you to lose the objectivity you need to see the client clearly and hear the client clearly.

In simple terms, projection happens when you are not aware of your feelings or needs so you ‘project’ them onto someone else. Projections can cause reactions such as always giving advice to a client. To become more present means to be able to feel the feeling that is causing the projection (are you following this? It is hard to understand since it is unconscious.)

Remember – this is an unconscious process. Everyone is unconscious most of the time. Since it is unconscious you are not aware of what you are really doing. Becoming more conscious is a very complex process. We live our lives with many blind spots. Some people won’t even believe they are doing something unconsciously because it seems so real. It is real.

The way to track your thoughts and beliefs is through your feelings and becoming more aware of them.

Supervision is one such way of interaction that helps you to become more self aware.  Supervision is not someone telling you what to do in the regular definition of supervision in the workplace.  Supervision is the process of working with a more experienced massage therapist in order to understand your practice issues more and help you become more aware of yourself.  You can learn more about the process of supervision on the website.

Working with a skilled psychologist can also take you deeper into your old patterns of behaving onto can do wonders for your massage practice and personal life. Since all relationships start in transference and the therapeutic relationship has a way of intensifying that transference it is important to find out more about your unmet needs. For the most part all we can do is grieve the loss of never having had them met as it is too late to get them met. Then it is a matter of taking personal responsibility for yourself and actions.  The more you take care of yourself, your unmet needs and deal with the emotions, the more present you are able to be in your sessions and be there for clients.   The more you take care of your internal self the easier it is to do those external self care things like setting boundaries around your time and financial needs.

See also : Understanding Projections

Handling Projections

Why do you do massage?

Related posts:

1. Countertransference for massage therapists
2. Transference for Massage Therapists
3. The therapeutic relationship for massage therapists

Ben Benjamin author of the book “The Ethics of Touch” defines transference as this:

Clients defer to the practitioner’s judgment because they desire to be helped by an authority figure that possesses greater knowledge, healing ability and, therefore, power.

Since a power differential exists in any health care relationship, the client may be inclined to respond to the practitioner as he or she would other authority figures, and in doing so, may recreate elements of similar past relationships. This situation is known as transference, a normal, unconscious phenomenon that appears during a therapeutic process. Professional helping relationships usually have a strong transference element in which the parent-child relationship is unconsciously re-established. In transference, unresolved needs, feelings and issues from childhood are transferred onto the helper.

Elliott Greene author of the book “The Psychology of the Body” writes this:

Transference is the displacement or transfer of feeling, thoughts, and behaviors originally related to a significant person, such as a parent, onto someone else, such as the massage therapist. It is a common reaction of clients to their therapists. A bit of transference happens in most relationships in which there is feeling present. Usually, transference-related feelings were formed in the past, so it could be said that these feelings transfer from the past to the present. In transference then, the client relates to the therapist and present moment as if the therapist were the significant person. In this sense, transference is a projection of the internal drama of the client, and the therapist is assigned a particularly important role and script.”

Nina McIntosh in her book “The Educated Heart” says this about Transference.

“Transference may sound complex and unusual, but it’s actually part of our everyday life even outside of our offices. It’s normal for any of us to bring the past into our present relationship. In fact it happens all the time. They are magnified ina manual therapy session because of the intimacy of the setting, the clients altered state and the way that the practitioner/client roles mimic those of the parent/child.”"Transference isn’t a rational process.

Terrie Yardly-Nohr in her book “Ethics for Massage Therapists” says this:

“The very nature of the therapeutic relationship allows transference to happen easily. Bodywork can trigger a variety of emotions from clients such as anger, frustration, sadness, fear, or joy. These feelings are generally the result of some emotion the client felt in the past towards another person.”

Cidalia Paiva in her book “Keeping the Professional Promise” says this:

“Transference refers to those situations where the patient projects onto the therapist old feelings or attitudes they had about significant people in their past, often parental figures. Transference is often referred to as ‘the unreal relationship in therapy’. The roots of transference are most often found in early childhood, and it constitutes a repetition of past conflicts with significant people in our lives.

So what is transference then?

Simply put, transference happens when there is difference in authority that resembles the parent-child relationship. The client who comes to a massage therapist receives the nurturing that they never received as a child and puts the massage therapist on a pedestal. The nurturing touch brings out the old feelings and emotions that were repressed or suppressed in early childhood. The client unconsciously begins to see the massage therapist as the nurturing parent and it can bring up feelings of attachment that were not resolved growing up. It is when the client unconsciously thinks that the massage therapist is their mother or father or other significant caretaker. Note the word – UNCONSCIOUS.

Attachment is what happens between a mother and child that allows the child to grow and build self esteem. The infant knows learns about themselves through touch. There are various stages of attachment that occur in child development where the infant feels like they are one with the mother. (And of course they once were in eutero.) As a child grows they learn that they are separate from the mother. This is where things often go astray. If a secure attachment is not formed in their early part of life, they will have life long challenges that result from that.

Massage and nurturing touch re-enacts the process of development. I actually think this is also why spa treatments are so popular with the use of healing waters and body wraps. Getting regular massage and developing a relationship with a massage therapist in which the client feels nurtured and cared for as if they were receiving it from their mothers can help heal the grief of not ever getting those early childhood needs met.

Transference is really important yet difficult to understand. The best way to understand it is to experience it. You may or may not have had some of these feelings arise when you were getting a massage from someone:

• Feeling like you don’t want the massage to ever end
• Not wanting to leave the office
• Seeing the massage therapist outside of the office and wanting to follow them where ever they go.

Or from the other aspect seeing it in your clients:

• bringing you flowers or special gifts
• hearing about people’s personal problems
• being asked to make exceptions in scheduling and payment options.
• inviting you out socially as a friend
• asking you out on a date or making other advances on you.

Or if you ever worked with a psychologist or mental health professional in therapy, you can come to learn more about transference from seeing your own. Becoming aware of your projections in a therapy setting can be a painful experience. It is a matter of getting a look at your unconscious thoughts through relationship. It can be a very eye-opening process and really lasts a lifetime.

While some of these things may just seem like normal things, it is difficult to know the difference. You probably won’t know the difference.

What you can do is create a code of ethics and a set of policies and procedures for your practice that will help you make proper decisions in any situation. It is having boundaries that teach people when they are in transference that you are separate from them is what will allow the person to heal and build self esteem.

The other thing about transference is that it not only occurs in these helping types of relationships but almost all relationships. Friendships, significant others, family members and the person who checks you out at the grocery store who seems to ‘look just like your mother”.

Reading and learning everything you can about transference can also help. These are some of my favorite books:

Getting the Love You Want: A Guide for Couples, 20th Anniversary Edition

Take Me To Truth: Undoing the Ego

The The Psychology of the Body (Lww Massage Therapy & Bodywork Educational Series)

Ethics for Massage Therapists

The The Educated Heart: Professional Boundaries for Massage Therapists, Bodyworkers, and Movement Teachers (LWW In Touch Series)

Issues and Ethics in the Helping Professions
On Becoming a Person: A Therapist’s View of Psychotherapy

Related posts:

1. Countertransference for massage therapists
2. Dating Massage Clients
3. Speaking of Transference.

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?

Related posts:

1. Proof of Harm
2. Massage Therapy Training
3. Proof of Harm in Massage Therapy

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?

See also:

Male issues discussed at www.thebodyworker.com

The Male Massage Therapist -www.male-massage-therapist.com

Related posts:

1. Men – Will they be successful in a massage therapy career?
2. Men as massage therapists
3. Massage Therapists in a Money Fog

1. 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.
2. 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.
3. 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.
4. 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.
5. 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
6. 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.
7. 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.
8. 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.
9. 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

Related posts:

1. The State of Billing Insurance in Washington State.
2. Can a massage therapist bill insurance companies?
3. Massage Insurance Billing Manual

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.

Related posts:

1. The Gift of Pain
2. Compassion Index
3. Effective Massage Therapists Master Their Emotions

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?

Related posts:

1. Creating Policies and Procedures
2. Cancellation Policies for massage therapists
3. Recession Proof Your Massage Business