Making Tough Choices

By laura Allen
[Business Side]

All licensed professions have a code of ethics—a document spelling out certain rules of moral behavior that all agree to abide by—in the interest of public protection.

Along with doctors and other medical professionals, massage therapists work with people who are unclothed and in vulnerable positions, making it all the more necessary to conduct ourselves in an ethical manner. Yet, we’re all human, with all our particular faults, and products of our raising. One person may have been in a home environment where high morals were modeled and expected, while another may have grown up in bad circumstances without positive examples.

The study of professional ethics is probably the most important part of a massage education, but many schools give it no more than a cursory swipe. One student recently complained, “My teacher doesn’t like ethics, so she spends that time just talking about something else.” Many programs tend to exclusively focus on what to do if a client makes a sexual overture. Unfortunately, that approach doesn’t even begin to address the subject of ethics. Before you know it, you’re out there practicing massage in the real world without a good foundation, and having to learn your lessons the hard way.          

Put Yourself in the Consumer’s Place

To borrow a phrase from the late Nina McIntosh, author of The Educated Heart: Professional Guidelines for Massage Therapists, Bodyworkers, and Movement Teachers (Lippincott Williams & Wilkins, 2010), “Ethics is just an educated way of being kind.” Put yourself in the consumer’s place for a moment. Don’t you prefer to do business with people you know to be fair and honest? If you’ve ever had a bad customer service experience, or felt as if you’ve been cheated or mistreated when doing business with someone, you know what I mean. If you get really bad service in a restaurant, chances are you will tell your friends how terrible it was. If you buy some piece of merchandise that falls apart immediately, and the store won’t make good on it, you’ll tell your friends.

It’s the same with the massage profession. Word of mouth is the cheapest and best advertising we can get. It’s difficult for any business to survive without repeat customers, and it’s difficult to survive unless your business continues to grow. If you depend on making a living from massage, you need to be able to replace clients as they leave, even if you’re not actively seeking new ones at the moment. Recommendations from existing and former clients can be your best avenues to success. But, if you’re conducting your business in an unethical manner, it can be your fast track to career disaster. That’s exponentially true if you practice in a rural area or small town, where word travels fast.

Let’s Talk About Sex

Violating the sacred space of the massage room with sex is the worst thing that can happen in a practice. For starters, it’s prostitution if you’re getting paid for the “massage.” A happy ending isn’t happy at all when you get caught, reported to the massage board or law enforcement, and gossiped about among the townspeople and your peers.

You don’t have to be committing a sex act in order to dance on the precipice of ethics violations. The Professional Code of Ethics (borrowed from Associated Bodywork & Massage Professionals, but most regulated state rules contain a similar sentiment) states that massage therapists will “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.” A thoughtless action like careless draping that leaves the client exposed is misconduct, whether intentional or not. It may not be fair to judge a book by its cover, but dressing provocatively (displaying cleavage, or showing a thong rising out of the back of your pants) could be construed as sexualizing behavior.

Your massage technique, general demeanor, and communication skills need to be self-examined periodically. Calling a client “Honey” instead of “Mr. Smith” or “Bob” can send the wrong message. Keep your behavior and language professional. There may not be a definition of “sensual” massage that everyone agrees on, but I’d know when I’ve had one, wouldn’t you?

Give Honest Value

If you advertise massage rates by the hour, do you give an hour of massage, or does that include the time you spend doing an intake interview? Lots of therapists seem to be on the 50-minute hour—and that’s fine—as long as you accurately represent it to the public.

Many massage therapists also practice energy work. A guiding principle of energy work is that you don’t practice it on people who don’t believe in it or don’t want it. Yet, many therapists will take up 10 minutes of the client’s session “clearing energy” before getting on with the massage. One client told me the therapist informed him that she spends the last 10 minutes doing reiki. He said he would prefer to have the massage he was paying for and she was offended. Imposing energy work on clients who don’t want it and haven’t requested it isn’t appropriate. If clients are paying for massage, give them massage, unless you have discussed energy work with them before the session begins. 

Your rates should be clearly posted in your literature and on your website, along with your cancellation policy. If you’re going to enforce a cancellation policy— which I highly recommend you do in order to protect your income—you must treat everyone with fairness. At my own office, I allow people one missed appointment without penalty. After that, they have to pay for the missed session. Since I live in a small town, this policy has to be enforced equally, or the word could get out that I charged so-and-so for a missed appointment, but I let so-and-so off the hook. A misstep can create ill will or even cost you clients.

Employers Behaving Badly

If you have others in your practice, whether employees or independent contractors, the litmus test for whether you’re running things in a fair and ethical manner is often how much turnover you have. If you have a constant stream of staff coming and going, it’s time for a long, honest look in the mirror.

Treating independent contractors as employees is probably the biggest complaint I hear from MTs. To clarify, an independent contractor is a self-employed person who is working in your space. If you’re requiring them to sit around on the premises for no pay when they don’t have clients, forcing them to do free desk duty, or making them do cleaning and laundry (other than their own space or their own sheets), you’ve crossed the line, not only ethically, but legally as well. The Internal Revenue Service (IRS) has Form SS–8 (available on its website,, which is used to determine worker status. Misclassifying workers, whether it’s a deliberate action or not, can result in big fines and penalties if you’re audited.

Fair compensation is another hot topic. As an employer of more than a dozen people myself, I am very familiar with the overhead that’s required to run a business. Fair compensation is a relative term, but again, the amount of turnover you have is an indicator on how you’re doing. Some employers pay hourly, some on a percentage basis. I’ve heard from therapists who were receiving as little as $10 an hour, or as little as 30 percent. When that’s the case, they don’t stay long; they’re looking for someone who will place more value on them and the services they provide—and someone will. If therapists are leaving as soon as they find the next best thing, consider this: it’s actually cheaper for you in the long run to compensate people well enough that you’re not having constant turnover.

Your staff members can make or break your business. When they’re appreciated, treated well, and compensated fairly, they’re going to help build your business. When they’re not, you (the employer) are swimming against the tide.           

Employees Behaving Badly

It’s not just employers who are guilty of unethical behavior. Many employers have shared stories with me about therapists stealing files and soliciting clients. The only person I’ve ever fired at my office—and I actually fired him for a different reason—was telling clients they could get their sessions cheaper if they would come to his house. Fortunately, he only lasted two weeks and didn’t have enough time to do much damage. After he left, I learned he had also stolen client contact information.

Employers often devote time and money to train their employees. A spa owner recently shared that she hired a new therapist, spent a couple of weeks training her in all the spa techniques, and, after a month, the employee announced “I’ll only be working for the next month, then I’m moving to Colorado.” She failed to mention this during the hiring process. She wouldn’t have been hired if the employer had known she was seeking such short-term employment, or the employer may have hired her as a temporary employee and spent less time and effort on her training.

The Right Choice

On a daily basis, we all face challenging situations and have to make choices. When you do something wrong one time, that’s a mistake. When you do it again, that’s a choice. Choosing ethical conduct is not just a good idea, it’s required. Your solid judgment is not only going to safeguard clients, it will safeguard you and your reputation as a businessperson. Let the code of ethics be the foundation your business is built on and you’ll thrive.

Laura Allen is the author of A Massage Therapist’s Guide to Business (Lippincott Williams & Wilkins, 2011), Plain & Simple Guide to Therapeutic Massage and Bodywork Examinations (Lippincott Williams & Wilkins, 2009), and One Year to a Successful Massage Therapy Practice (Lippincott Williams & Wilkins, 2008). Allen is the owner of THERA-SSAGE, a continuing education facility and alternative wellness clinic of more than a dozen practitioners of different disciplines in Rutherfordton, North Carolina. Visit her website at