Dirk McCuistion looked over the client numbers at his Boulder, Colorado, massage studio and pondered their puzzling implications. Since its opening, MassageSpecialists.com had always been successful in attracting clients—an average of 250–300 new clients per month. Yet after five years, the business wasn’t growing; its growth curve had flattened. McCuistion wondered how much longer his business model would be sustainable. The math frightened him.

“Boulder is a city of about 100,000 people,” he says. “We were seeing about 3,600 new people per year and we’d been in business five years, that’s about 15,000 clients. But if we’re getting 300 new clients each month, the fact we’re not growing means we must also be losing 300 clients a month. Where were those people going? At this rate, we only had a few more years before we ran out of new people in Boulder to work on.”

He began to look, he says, for “the hole in the bottom of the boat.”

The problem, he decided, was not in the clinical skills of the massage therapists he employed. As far as he could determine, they all knew what they were doing.

Rather, the problem lay in the therapists’ ability to communicate with clients: to find out exactly what problems the client was experiencing, what the client expected from the massage, how the client was experiencing the massage, and—most critical of all—educating the client to the potential benefit that a repeat massage could offer, then booking one.

“We found that communication is more important than any other skill, yet it’s something massage school graduates are woefully unprepared for when they enter the massage therapy field,” says McCuistion, who is also a certified massage and neuromuscular therapist and associate instructor at the Boulder College of Massage Therapy. As he began to identify what was causing that “hole in his boat,” McCuistion instituted new policies that, in effect, caused a paradigm shift at MassageSpecialists.com, which now has two studios in Boulder and one in nearby Denver. He designed a communication flowchart (see The Road Map, page 60) and instructed his employees how to systematically determine what the client wants and what the client feels he or she is receiving. He devised ways to objectify and quantify clients’ symptoms and their level of improvement following treatment. At the end of a session, the therapist’s suggestions for future bodywork are written on a prescription pad, which helps communicate the message that massage is more than a simple indulgence. McCuistion even asks the massage therapists on his staff to sign a “satisfaction guarantee” contract. If clients don’t get what they’re expecting, or leave dissatisfied, the massage is free.

“It’s not a guarantee that our massage therapist can fix something. We’re not guaranteeing an outcome,” McCuistion says. “We ask them to guarantee that they’ll communicate effectively during the session, so there’s nothing they miss.”

The emphasis is on getting new clients to leave as satisfied clients, and thus become repeat clients, and then to become regular clients.

It’s also about getting massage therapists to stop being shy about spelling out for clients just what benefits additional bodywork can offer, getting them to own that expertise, and being willing to pick up the phone and call clients to see how they’re doing postmassage.

“What gets in the way is massage therapists’ belief that they love what they do and they can’t believe people pay them to do it. What gets in the way is asking clients to come back and spend even more money on something that’s expensive,” McCuistion says.

“But why do we think massage is expensive? If I have a migraine, and I can come to you for a massage and afterward I feel so much better I don’t have to buy migraine medicine, that makes massage a lot less expensive. So why shouldn’t I communicate that to the client?”

Cultivating Stickiness

At MassageSpecialists.com, McCuistion closely tracks each therapist’s monthly numbers. He knows how many new clients each therapist sees each month, and how many of those come back for a second visit within 30–90 days.

He realized that the busiest therapists weren’t necessarily the best therapists. Thus, the therapists who are paid the highest hourly rate are those who bring back the most repeat customers, because those are the therapists McCuistion is most interested in maintaining as associates.

“It’s the ‘stickiness’ factor we now reward,” he says. “In the past, we created a culture of entitlement. The longer you were with us, the more you were paid and you got better shifts. But that didn’t recognize how you were actually doing in building your practice. The therapists who you pump 70 new clients a month to, if they don’t retain any of them, those therapists cost you money. This is where clinic owners really need to pay attention. It’s not the topline numbers you need to worry about as much as the holes in the bottom of the boat.”

The results have been remarkable, McCuistion says. Some therapists do a better job at this than others, of course, but overall retention numbers are up. Five years ago, before McCuistion launched his plan, only 4 percent of new clients at his Boulder clinic returned for a repeat massage within 30 days. Today, 22 percent do.

“New client retention is about the relationship between session one and session two,” McCuistion says. “Frequency is all about Session 2 to infinity. Successful massage therapists have high new client retention and also very high frequency. Frequency is the bread and butter of a practice. Most massage therapists make the majority of their income from a small number of people who are their best clients.”

Living the System

Not surprisingly, therapists aren’t always enthusiastic when first confronted with McCuistion’s systematized communication method. At first, it strikes many as too mechanical, too intrusive, and too pushy.

“To be honest, for the first couple of years I didn’t do much,” admits Nicola Rigby, who has worked at MassageSpecialists.com for three years.

Checking in with clients throughout the massage session, questioning to find out exactly what they were experiencing, and making sure she knew she was addressing their top areas of concern all became second nature to Rigby. But the postmassage conversations continued to trouble her.

“I sort of felt like, ‘If you like my work, you’ll come back.’ And I left it at that,” she says. “If they came back, I’d check in with them and ask how things worked last time, and what they wanted to do this time. But I wouldn’t do anything in between.”

With McCuistion’s urging, she began calling clients, following up on areas of concern they’d expressed, and doing research into potential strategies for addressing chronic problems. “I got in a pattern of sitting down with my list of clients once or twice a week, and just calling them. Ninety percent of them said ‘Wow! Nobody ever called me like this. Thank you!’”

She began keeping more detailed notes on clients. She made note of when runners or cyclists had events coming up, and she checked in with them afterward to see if they were suffering soreness or cramping. She also made note of those who were struggling with other issues, not necessarily physical. “I’ve been working to find ways to make those phone calls really express genuine care, not just seem like I’m calling for business,” Rigby says.

As a result, her practice has grown much more steadily in the past year. “It’s made me realize that people generally do want that sense of connection,” Rigby says. “They spend an hour or an hour and a half with me at a time. They probably don’t spend that long in a whole year with their physician. It’s made me realize that, as part of the health profession, we’re probably the most contact many people have with someone who genuinely cares about their health. We’re the people they can talk to about all the stuff that’s contributing to their stresses. It doesn’t just end in that hour or hour-and-a-half session. You really should continue that communication.”

Oliver Fisk, a veteran massage therapist in the Denver MassageSpecialists.com studio, has been among the most successful in the company at converting one-time clients into monthly regulars. But he, too, balked at first when he saw McCuistion’s communication flowchart.

“A communication model like that is almost always dry,” he says. “That makes it hard to swallow. If you followed this flowchart word for word, it would be boring. People don’t want you to recite something by rote, like a computerized message. But if you simply view it as a framework for the information you need to get out of your client, then it’s not.”

Dawn Adkins, another of the high-performing therapists in the Denver office, had similar feelings. “At first, I struggled,” she admits. “This was way outside my comfort zone. And I’m still working toward being successful with this. But I realized that before I started really communicating with my clients, I was in automatic mode a lot of the time. This has breathed new life into my practice. Dirk has created an atmosphere where I’m responsible for growing my own practice.”

Love at First Sight

Unlike many of his coworkers, Boulder massage therapist Ryan Stevens took one look at McCuistion’s communications flowchart and fell in love. “I’m all about anything systematized,” he says. “I thought it was the most brilliant communications thing I’d ever seen as far as engaging with clients. I was fully on board.”

But Stevens soon discovered how demanding possession of so much knowledge about a client’s needs and desires can be. Total clarity, he learned, is not for the faint of heart.

“Do you really want to find out what the heart of a client’s issue is if you have no idea how to approach that problem?” Stevens asks. “Dirk dumped this thing in my lap that’s genius, but I had to ask myself, do I really have enough of a skill base to deal with the stuff that will be clarified for me? That’s been the consistent struggle for me. It’s not enough to teach someone impeccable communication skills if they don’t know where to go from there.”

Stevens, a massage therapist for 14 years, says he’s driven to see his clients get results. In order to get those results, he’s constantly learning new skills, and honing old ones, so he can better deal with the array of problems presented to him.

“I’ll lay it all out for my clients,” he says. “I’ll say, ‘For your pain to diminish, it could take this long,’ and give them a general outline of a plan. And we’ll have check-in points where we’re constantly revising. From moment one, we’re setting up the possibility of something that’s so much more than just a drop-in session for a relaxing massage. That’s retention for the sake of service, not for the sake of propping myself up as a practitioner. That’s service at the highest level.”

Rebecca Jones is a tenured Massage & Bodywork freelance writer. She lives and writes in Denver, Colorado.
Contact her at killarneyrose@comcast.net.

The Road Map

Dirk McCuistion’s communication flowchart for massage therapist/client conversations covers much of one wall in his office. It’s a color-coded, step-by-step guide to eliciting every shred of information that could be useful in treatment.

He’s not willing to share it in its entirety: it’s proprietary and McCuistion uses it extensively in his consulting work.

But here’s the gist of it: Ask direct questions and don’t settle for vague answers. Keep pushing until you get specific, quantifiable information, and you’re totally clear on what the client wants and what the client means.

A session with a client may begin with a simple enough question: “What can I do for you today?”

The client may respond, “I just want to relax.”

That’s not enough information, McCuistion says. Something is going on, but the client may not know how to communicate the problem. It’s the therapist’s job to probe further.

Therapist: “What does that mean? Do you feel tension somewhere? What do you notice in your body right now?”

Client: “My right shoulder is tight, and I have a headache.”

Therapist: “Tell me more. Does the pain shoot up your neck? Is it in the front of your head? The base of your head? What position do you sleep in? What kind of work do you do? How long has this gone on?”

Keep probing, McCuistion says, and try for descriptions of pain that can be measured:

Therapist: “Think of your worst headache ever, then tell me how this one compares to that one. Where is it on a scale of 1–10?”

Only begin the massage once you’re certain you know exactly what the client is experiencing, and what the client hopes the massage will accomplish. Make the client’s priorities your priorities for the massage.

“Every client who comes in to a session has an agenda,” McCuistion says. “There’s a specific expectation of what will happen in that session, even if they haven’t clarified it in their own mind. If they don’t get what they wanted, they won’t come back to you. You have one chance to deliver, so don’t take the chance that you missed something they wanted.”

Once you’ve begun the massage, check in frequently. Make sure you’re using just the right amount of pressure.

“I use a 1–10 scale to describe pressure,” McCuistion says. “Say a 7 is the edge of good pressure, and 8 is too much. I’m pushing you a bit with a 7, but you can still relax. At 8, you can’t. It’s based on what’s too much for you. If you want me to work lighter, you’ll tell me 7 is a lighter pressure. If you want me to work deeper, you’ll give me a lower number, so I know I’ve got more latitude.”

McCuistion never lets clients get away with simply saying, “Good,” when asked how they’re doing. “Good tells you nothing,” he says. “The only thing it tells is that it could be better. Or it could mean, ‘It’s not good, but I don’t want to tell you that.’ Or it could mean, ‘I don’t want to tell you how to do your job.’ You can’t settle for vagueness. You have to be really dogged about getting to what’s happening, because if you allow the client to be vague, you’ll lose that client.”

Therapist: “Is that a 6 on the pressure scale?”

Client: “No, it’s a 5.”

McCuistion acknowledges this level of hair-splitting can be annoying to a client—especially one who just wants to relax. So these issues need to be settled early in the massage.

“If a client says, ‘Dirk, I just want to relax and zone out,’ that’s an indication they want me to talk to them less. So I’ll say, ‘Can I count on you to inform me when you want more or less pressure? And is it OK if I check in on certain things?’ You have to come to an agreement with the client about how much you’ll communicate during the massage. Talking to them about the movie you saw last weekend is not appropriate. That’s just distracting.” On the other hand, if you come across a mole that looks suspicious, advise them to get it checked.

Once the massage is finished, resume probing for objective measures of what the client has experienced.

Therapist: “You came in with a headache. How is it now? Is it 50 percent better, 30 percent better? Is it gone? Is it worse?”

“This makes the massage therapist accountable for the results,” McCuistion says. “It also informs how you talk about their plan for the future. This is what practice building is about. It’s delivering on results.”

Therapist: “If you get a headache once a week, then it makes sense for us to see you again. If you’re 30 percent better now than when you came in, it makes sense for us to see you again. But if this is just an isolated incident, and you usually don’t get headaches at all, then you should be able to get by just by doing some simple stretches.”

“Every session is a chance to knock it out of the park and meet the client’s needs,” McCuistion says. He says therapists don’t have to pretend to know everything. Those who admit they don’t—admit that something they tried didn’t work and that a different approach might have better results—ultimately gain greater trust and confidence from clients.

 “One of the most powerful things a massage therapist can say is, ‘I don’t know, but let me research it for you.’ It creates a rapport with a client, and deepens a relationship,” McCuistion says. “It’s not about taking a client’s money. It’s about massage therapists living out their greatest intention, which is to help people.”