Julie Onofrio

Informed consent is one of the most important parts of the therapeutic relationship and building a massage therapy business. You inform clients of what you are going to be doing and why and everything about what you know so they can be informed and clear about what they will be getting. They get to have input into the care that they receive. It also is what will protect you when a client makes a claim against your liability insurance or makes a complaint about you. It is the basis for a safe experience for both the client and the therapist. It is the foundation of the therapeutic relationship and building a successful massage business.

From the minute they start searching for someone to give them a massage, either online or by asking friends and doctors for referrals, a person that will get initial impressions of you which starts the process of the therapeutic relationship.

Clients must be informed of:

• Who you are and that you will be working with them.
• Your work hours, fees and policies.
• The background, history, tradition or evidence of your work.
• Your training and experience in learning the massage method. How many years of training and experience, classes taken, teachers and reputations, board certifications or certificates (know the difference).
• The benefits that should come as a result of the work. Know your research.
• The risks involved in getting the massage.
• How people may feel before, during and after a massage.
• What to expect during a massage session with YOU. What areas of the body will you be working on and how. What areas of concern do you and the client have?
• Describe sessions in a language that is simple and clear, explaining technical terms. What happens from the minute they think about trying you for a massage – the website, scheduling, cancellation policies, appointment times and days, techniques you will use and how feedback will be handled. Assume that people know nothing about massage or the work you do.
• Clearly state your scope of practice and that you are not able to diagnose anything.
• Policies and Procedures including cancellation, no show, late arrivals, payment at the time of service, late fees, no payment or delay of payment fees.
• What is expected from the client – being on time, draping, how to behave (no sexual advances).

Clients must be capable of making a decision for themselves and not be influenced by marketing, hype or rhetoric. A child may need parental consent.

Right of Refusal.

A client has the right to refuse treatment at any time before or during the session. The client should be able to ask questions at any time and stop the session at any time. They should be allowed to give feedback and have it be heard. This is often one of the most difficult things for clients to do when they are undressed and in a vulnerable space.

Informed Consent Forms

Having a client sign a consent for usually should be enough, but many do not fully read those forms.

Informing Clients

Beginning with first contact which is often a Google Business Listing or finding your website or talking to a friend/coworker/family member about you, your messaging needs to be clear and consistent. Your website should tell what solutions you provide as well as have your policies and procedures listed.

As you work with people on the massage table, you can also use this as an opportunity to inform them of everything you are doing especially if they have never had a massage session or had a session with you. Tell them how to lie on the table -under the sheets, face up or down or side, covering up, level of undressing and whatever is needed to help them feel comfortable. Tell them what you are doing before you do it —like I am going to massage the gluts or adductors or pec minor— and I am going to do this and this and you may feel this or this.

Documentation

The intake process and documentation of the session will help protect you in conjunction with the informed consent. If you did not document it, it did not happen.

Starting and running a massage business is not an easy thing to do. So many start and try but get nowhere. Some blame it on their limiting beliefs or that they don’t have the right mindset. The whole concept of mindset is just one theory. Then there is the positive thinking way—just think positive thoughts and you will get what you want.

I used to follow all that and put hundreds if not thousands into books, classes and learning the ‘law of attraction”. I even put up a website at one point on the law of attraction.

Then about 10 years ago or so, I found the writing and words of Barbara Ehrenreich who talks about how positivity is a joke.

We need to brace ourselves for a struggle against terrifying obstacles, both of our own making and imposed by the natural world. And the first step is to recover from the mass delusion that is positive thinking.”

So what are we to do

The whole you have to change your mindset, you have to be more positive is just another way you are beating yourself up. It is OK to feel bad, to not have a positive mindset, to not have a growth mindset. At the basis of positive mindset and growth mindset theories is usually the beliefs you have about yourself that are mostly unconscious. It is the little voice that is always saying some version of “You are not good enough. You are a monster. You don’t have what it takes.”

Can you ever really get over that, change that and get rid of it once all? Personally, I don’t think so after 64 years, 25 years of therapy, 20 years of supervision, years and years of reading every self help book around. (If self help books worked, we wouldn’t need them anymore.) It will always be with you in some form or another. The thing that we can do is come to know what that ‘not good enough’ voice is running the show and do what needs to be done anyways.

Here’s the key: You can have those beliefs, you can have whatever kind of mindset, you can be positive or negative and guess what— You can still be successful.

What you do need is commitment.

Are you willing to do what it takes to start and run a massage business? That could mean just about anything:

• Are you willing to work a part time job or even a full time job while you build your business?
• Are you willing to work long days, weekends, evenings and at other times to accommodate people’s schedules? (yes you might have to in the beginning.)
• Are you committed to figuring out a marketing method that will work for you to bring you the clients you need? That could be learning to use Facebook, learning to create a website, learning to use Google Business, learning to use Groupon, learning to do free events (yes), learning how to build repeat clients, learning how to get referrals and whatever way or method YOU find or create that works for YOU. (Any one of these things takes 6 months or so to learn or more.)
• Are you willing to keep trying and learning from each failure? Did you try a Groupon and get exhausted from the number of clients and low pay? Did you try to ask a few people to rebook for next week and it didn’t work so you gave up? Or did you ask every single person until you perfected the art of rebooking clients? Did you try one free event and feel like you got taken advantage of? Or did you try and try again until you perfected the art of turning free events into getting clients?
• Are you willing to go to the office everyday even if you don’t have clients?
• Are you committed enough that you have set up daycare, your home life and your schedule to make your business first?
• Are you willing to show up even in the face of things like deaths in the family, struggles in your personal life,

You probably reacted to some things on the list and were taught otherwise. Don’t do groupons. Don’t go to the office if you don’t have clients. Don’t work all hours of the day. Work only on your ideal client. I don’t know where all that is coming from but it requires that you start understanding that it is a business after all.

“What is the one thing that would upset me if, at the end of my life, I do not attempt, do, or complete?”

Giving massage to pregnant women, from conception to birth and postpartum is one of many business models for massage therapists. If you are going to focus on that, you will need to have extra training in pregnancy massage as well as clinical massage to be able to work with women through various stages of pregnancy and work with the various conditions that they may be faced with.

You can take classes as well as read books and articles online to be informed.

Massage may be given in any stage of pregnancy contrary to some information being taught or having been previously taught in massage school.

1. Website. Starting and running a pregnancy massage related business will require you to create a very content rich website talking about every stage and the massage applications. Your website needs to show that YOU are the expert in this area in your neighborhood. You will want to focus on the results you get when working with pregnant women. Talk about the various possible conditions that may arise like back pain, hip pain, carpal tunnel syndrome and other common conditions. Read more on everything you need to know about creating a website that works.
2. Rebooking clients. This one is easy with pregnant women. The next 9 months will be filled with challenges both mental and physical. Getting regular weekly or monthly massage can help support a mother to be through this time. Get the results that your client wants and they will easily rebook.
3. Getting Referrals. You may want to take the next step and connect with expecting mothers. Look for local Facebook groups with the focus of having babies. Look for doctors near you that specialize in labor and delivery. That is really best done by working on a pregnant woman and having her talk to her doctor about you and tell what a great job you are doing to open the door instead of just cold calling.
4. Ethical Practice. One of the challenges you may be faced with is the mother/client asking you questions about the pregnancy and delivery process that are really out of your scope of practice even though you may have extra knowledge on the various stages and procedures. It is important to clarify that they need to work with their doctor on everything. You may want to work with a supervisor yourself to keep yourself clear and get the support you need. You can learn about the advice giving issues.
5. Self Care. Taking care of yourself so that you can be present with expecting mothers is essential.
6. Is pregnancy massage covered by health insurance? For the most part, pregnancy massage is wellness or relaxation massage that is not covered by insurance. If there are problems like back and hip pain or carpal tunnel, insurances would be more likely to cover it. Most states do not allow for health insurance to cover massage of any type although many plans are now covering things in various states. There is also a grassroots movement to make it happen. See more on the Healthcare Integration page or Learn to bill Insurance for Massage.

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