Cost Versus Value

By Robert Chute
[Practitioner Parables]

Whenever I’m tempted to think I’m a rockin’ therapist, Chad is always lurking to keep me humble. I was squeezing his thenar eminence when he felt moved to share with me how much he loved my work.  

“Thanks,” I said.

“However,” he added (and I wish he hadn’t), “I have a great job with full insurance coverage. If massage therapy wasn’t basically free for me, I wouldn’t be here.”


Then there’s Ben. Ben has a neck made of piano wire and concrete that gives him headaches. Massage makes it go away. As long as his sessions are covered by insurance, he’s a regular. When the coverage conks out around November each year, he’s gone until it kicks in again. He suffers. It’s unfortunate he feels therapy has to be free in order for him to show up.

Then there’s Jess. When she first came to see me, she was a woman in pain without a diagnosis. One shoulder kept creeping up toward her ear. Headaches incapacitated her. When menopause hit, hormonal issues compounded her pre-existing physical problems. I sent her back to her doctor. Little came of that and my next referral was to a naturopath. Between chiropractic, massage, and remedial exercise, her neck tension was decreasing and her posture was straightening out. But the bills were adding up, too.

Early in the year, Jess called. “I won’t be coming back to you for further treatment,” she said.

My mind flashed back to our last session. My first response was to wonder if I had done or said anything wrong. I couldn’t think of anything, but I didn’t have a script ready for this kind of call.

Finally, Jess put me out of my misery. “I can’t afford to come see you anymore. We just got through the holidays and I did the books. It was not a good year.” Her financial situation had changed. Food, shelter, and the need to have some cash in the bank trumped everything. Even her pain.

There are a number of alternatives if you want to ensure continuity of care. You can suggest less expensive therapeutic options. The local massage schools have student clinics that are inexpensive. You can offer shorter sessions. You can even work for free, if you can afford to do that.

I went over several options with Jess. She thanked me for my work. She will be back when she feels she’s ready. To bad Jess doesn’t have the coverage Chad takes for granted.


The names are not real. The sadness and hope are real. Contact Robert at or follow him on Twitter: @RChazzChute.