Getting Comfortable with Money
Business Side
By Nina McIntosh
Originally published in Massage & Bodywork magazine, August/September 2001.
Copyright 2003. Associated Bodywork and Massage Professionals. All rights reserved.
Many of us have an uneasy relationship with business finances. We feel awkward going from being the "Caring One" when a client is on the table, to being the "Cashier" at the end of the session who says, "Now gimme' 60 bucks." We feel a little guilty about money.
A bodyworker said recently, "I'm not in this for the money. This work is like a calling for me." For those with that attitude, there's often an accompanying anti-money sentiment. There's nothing wrong with wanting to make the world better, but there's no need to feel awkward or guilty about money either. Part of what professional means, after all, is that this is how we pay the rent. Charging appropriate fees tells a client we're serious about our work.
Massage school directors report that students generally have a hard time charging for their work. New practitioners feel uncomfortable because they think they're charging people for nurturing them or caring about them. A colleague has this advice: "Tell them clients are paying for their time. The caring is free."
The Case for Money
Actually, the exchange of money is part of what makes clients feel safe. Money clarifies clients' obligations to us and ours to them. The exchange of money helps clients feel comfortable with receiving what we give them. They know what they owe us in return. Money is clean, it's precise, it's simple. It balances the relationship.
Paying for services is an important part of the client's healing process, not an unpleasant bit of reality we tack onto the "real" healing process. Throughout the world, fees are an intrinsic aspect of healing. Jerome Frank studied many kinds of health care providers -- witch doctors, traditional Western medical doctors and alternative health practitioners. In Persuasion and Healing, he describes the ways an effective therapeutic experience involves the patient/client making a sacrifice. In cultures other than our own, the sacrifice might be a nice fat chicken. In ours, it's usually money.
The idea of the healing value of sacrifice doesn't justify greed or over-charging, but the concept can help us feel more comfortable with collecting appropriate fees. The element of sacrifice may give clients a deeper sense of the treatment's value and help them benefit from it. Many manual therapists have discovered that clients who are given a "special deal" or who are undercharged never seem to get as much out of the work as those who pay full price.
The exchange of money provides clarity, it's part of a safe professional environment. It validates both practitioner and client. The giving and receiving of money speaks deeply to us about our worth and the value of our work. For clients, it's a tangible sign of how much they will invest in their own well-being.
Different Modes
The part of us that empathizes with clients and the part of us that makes budgets and deals with money are two different aspects of our personalities. Sometimes it can feel awkward to make a transition between the two. Doctors and people who do volume business resolve the conflict by having another person, an office manager, handle the finances. But most of us are stuck with the dilemma of sliding back and forth between Caring One and Cashier.
We've just finished a session in which we felt touched by a client's revelation of the pain he feels in his life, and we're feeling compassionate toward him. As he gets ready to pay, he says, "Oh, do you mind if I post-date this check for next week?" Or, "Gee, I forgot my checkbook. Mind if I pay you next time?" How do we then say, "I prefer that you pay me at the end of each session," without feeling callous? Much easier to say "Oh, sure...that's fine," even if it really isn't fine.
The majority of us don't come to this work with a business background. We spend much of our time in school learning our trade, not learning how to sell ourselves and collect our fees. To move past any blocks we might have, we have to put extra energy into educating ourselves through mentors, classes and supervision.
Money and Sex
Money is like sex -- we talk about it all the time, but rarely do we talk about it honestly or openly. When openness is lacking, we don't realize others are struggling with the same issues. We don't learn from each other's mistakes and we can't support each other.
Is there a practitioner who has had perfect judgment about the financial part of the business...and do we even know what "perfect" would look like? Is there anyone who hasn't backed down from charging a client for an appointment canceled at the last minute, who hasn't given a special discount that backfired or who hasn't ever under- or overcharged?
Money is also like sex in that it brings up strong feelings. Many of us have old, unexamined ideas that get in the way of our judgment. We might have deep feelings about whether money is "good" or "bad," or whether we are competent with it. We might have unrealistic ideas about how hard or easy it is to make a living. Also, we have to come to terms with cultural values that measure personal worth by one's bank account. Working in a profession that usually doesn't make us rich, we have to learn to value our work even if we probably won't become millionaires (or even close).
Money is also like sex in that we can lose clients very quickly if they misunderstand our intentions or we become careless about boundaries. For instance, suddenly changing fees without notice can be jolting to a client, as can charging for a missed appointment without having explained our policy at the outset.
Because we have strong feelings about money, there's all the more reason to talk about it -- with a mentor or with a support group of peers. And all the more reason to be clear with ourselves and our clients about financial policies. Because we can be swayed by strong feelings, we want to stick with our policies unless we have a carefully thought-out reason to make an exception.
What to Charge?
Starting a practice, most of us can judge what the going rate is for our brand of manual therapy at our level of experience by researching the fees other manual therapists charge. All the same, we still want to give careful thought to what we charge. Our rates affect what both clients and colleagues will think about us.
If we charge more than the norm, some clients may be put off, while others may think we must be offering something special to be charging extra. If we charge less than the going rate, some may be attracted to the bargain, but they may not value the work as much.
If we charge a good deal (maybe $20) over or under what others are charging, we run the risk of alienating our colleagues. Sometimes even $10 a session over or under can set a practitioner apart. Colleagues may feel we're arrogant if we charge more than they do without having more training or experience. They may feel we are undercutting them if we charge less than the usual fee. Mostly, we want to settle on an amount with which we feel comfortable. If we're not comfortable, people will sense it.
Talking to Clients About Money
When we talk with clients about money policies, our attitude and tone make a world of difference. We want to sound straightforward, business-like and confident -- not apologetic or punitive. For instance, if we have to let clients know we are charging them for a missed appointment, we can simply say, "As you know, I charge full fee for a missed appointment." Of course, we want to make sure they know from the beginning what our policies are.
Clients want to go to practitioners who are confident. If we give notice we will be raising our fees, for instance, we don't need to sound apologetic. As a colleague said, "We don't need to send clients a sympathy card when we raise our fees." Tone makes all the difference.
The Perils of the Special Deal
What about giving discounts or using sliding scales? Most of the people I interviewed found it works best to stick with one fee -- with rare and well-thought-out exceptions.
The money arena is one in which we're likely to feel tempted to make special exceptions for clients. Making exceptions occasionally works out and is appropriate, most of the time, it's a mistake and a sign of deeper problems. We want to treat each client as a unique person, but we can run into trouble when we start bending money boundaries.
When we give a discount or use a sliding scale, we're automatically creating a dual relationship. We become the client's banker -- involving ourselves in his finances. As practitioners, we shouldn't be concerned with how much or how little money a client has. Dual relationships create complications that can interfere with our ability to put our heart into our work.
Imagine this scenario: A client has convinced you that, as a student, she can't afford your full fee. You have agreed to accept $40 per session instead of your usual $60 fee. After you've seen her for a month or two, she tells you she can't make the next week's regular appointment because she's taking a vacation to Hawaii. How do you feel?
Or the same client comes in after a month or two and complains she's not getting enough from the work, that she doesn't feel as good as she wants to. Are you able to handle this complaint with the same objectivity you would if she were a full-fee client? Or do you judge her as ungrateful?
Sometimes schools or individuals give discounts to groups of people, such as students, people with life-threatening illnesses, or spiritual/religious teachers and ministers. A special fee can work well if it's motivated by our hearts or our convictions and not by guilt. When we make such an exception, we need to keep checking in to make sure our hearts are still in it and our bank balances aren't suffering.
Even when we do pro bono (no fee) work or discounted work that seems purely altruistic, we want to look at the difficulties that may be hidden in such relationships. Good questions to ask ourselves any time we consider reducing fees are:
- Do we have a standard policy for fee reduction and are we veering from that policy?
- Are we uncomfortable with saying "no" to this client?
- How do we decide how much discount to give?
- Is there any way we foresee coming to resent or regret the arrangement or wish it were different? Will we feel owed?
- What are the possibilities the special arrangement will harm the therapeutic relationship?
By not carelessly making special deals, we protect both ourselves and our clients. The special financial arrangements we make for clients often don't help them. When we go outside the usual fee structure, it can confuse clients: they can end up feeling uncertain what their obligation to us is. They also may wonder if we can adequately provide a safe, consistent environment or if we will continue to change the boundaries.
When a session is free or at a reduced rate, we need to be especially careful with other boundaries. It would be confusing to a reduced-fee client, for instance, to also allow him to come in twenty minutes late for a session. (It would be confusing to anyone but especially for someone for whom we are already bending boundaries in other ways.) Such allowances can also create resentment in us.
Sometimes there's a bit of an unhealthy "rescue" attitude in a special deal. In an unhealthy "rescue," we, usually unconsciously, treat the client as if he were in some way inadequate and therefore, not able to be held to normal business arrangements. Sometimes clients attempt to manipulate us into such thinking. Sometimes, we may think giving a client a special deal shows our compassion. All of these motivations are different from making an adult-to-adult business arrangement with someone who has a legitimate reason to need a discount. Unhealthy rescues always backfire. When we depart from our normal framework, we encourage clients to do so.
A colleague reports: "After I made a special payment arrangement for a client who said he was down on his luck, he missed two appointments without giving me notice. After we were finished with our work, I had a hard time collecting what he owed me."
It would be difficult to make blanket statements about when it is appropriate to give a discount. Some practitioners can handle giving discounts and making special arrangements more easily than others. We have to know our own limitations and biases about money. The bottom line is whether the arrangement could be harmful to either us or the client.
Missed Appointments
You've arranged your life to see a new client at 3 p.m. You're not at the movie, you're not taking a nap, you're not hanging out with your buddies. You have kept that slot open for that client and you're all prepared: you've warmed up the room, put clean sheets on the table. Maybe you were counting on the money and you've already mentally spent the $50. And what happens? No show. No phone messages to explain....nothing. The missed appointment is that dreadful thud in the professional life of a manual therapist.
Along with the dreadful thud goes the pesky question of whether to ask the client to pay for the missed session. Most manual therapists usually charge for a missed appointment unless there's been an emergency. But what constitutes an authentic emergency is a judgment call. Illness rarely comes on suddenly. Cars don't often just stop working. Traffic is usually predictable. Sometimes no-show clients can't anticipate problems, but often they can.
Many of the manual therapists I interviewed were flexible about missed appointments, for instance, some don't charge the first time a client misses. However, standard practice is to charge full or partial fee for a no-show. Some practitioners -- especially new ones -- find it hard to ask a client to pay for a missed appointment. They feel awkward asking payment for "doing nothing." The point is that the practitioner could have booked another client in that slot. It's time and money lost.
If the no-show client doesn't call to explain or to make another appointment and won't return our calls, obviously we can't do anything about it. Such a client probably wouldn't respond to a written bill either. Sometimes practitioners are concerned about making the client angry, so they rationalize that they wouldn't have filled the vacancy anyway. Nevertheless, do we really want to work with a client who doesn't respect our time? If we feel angry with a client for missing appointments without notice, can we be compassionate when we work with her?
Sticking to our guns about charging for missed appointments shows we value our time as professionals. In this instance, maintaining boundaries protects us and helps us feel safe. The flip side is that we show clients the same courtesy, letting them know if we have to cancel their appointments without 24 hours notice, they will receive a free or discounted session.
Even with a firm policy that has been communicated to clients, we will always have an occasional no-show. I've had no-shows from clients who have heard my policy twice as part of a standard orientation and who have also signed a written agreement. Here are some suggestions to make missed appointments less frequent:
- When clients make their first appointments, always tell them they will be charged for appointments canceled without 24 hours (or whatever we think is adequate) cancellation notice.
- Have clients sign an agreement to that effect the first time we see them. Even if we are sure we have told them, they may not remember we did.
- Tell unreliable clients they need to call us by a certain time the day before the session to confirm the appointment or we will fill that time slot with someone else.
Refunds
It's often wise to offer an unhappy client a refund or partial refund even if there has been no negligence or harm on the part of the practitioner. If a client is upset enough to want fees refunded, we're generally better off giving the money back. Practitioners may want to consult a lawyer about how best to handle a specific situation.
If a client is harmed or neglected during our work with him -- whether or not we were totally responsible -- then we want to make it up to the client.
A woman had received four sessions from a bodyworker. The fifth one was 20 minutes shorter than the others and the quality of the work seemed below the previous quality. After leaving his office, she realized she felt short-changed and called the bodyworker, explaining what she had noticed. He told her she was right -- he had been on the verge of catching the flu when he worked with her. He didn't apologize or offer a refund or discount on another session. The client never went back to him and didn't refer anyone else to him.
This example doesn't mean that whenever we feel we have performed less than our best, we should rush to offer a free session. Those who are self-critical would be constantly offering free sessions. It does mean that when a client feels short-changed and has reason to feel that way, we want to make it up to him. Regardless of whether we had control over the situation that caused a client's discomfort, not charging full fee or refunding our fee is the smart thing to do if we want to continue seeing the client. An example of this is a massage therapist who charged a client for only half a session when the last 10 minutes of the hour were disrupted by the loud barking of the neighbor's dog. (Although we may not be able to control the neighbor's dog, it's our responsibility to provide a quiet environment for the session.)
Advertising
Manual therapists are essentially running a small business and small businesses advertise. Many of us don't have previous experience in business or as entrepreneurs. We may be uncomfortable with basic business practices and feel the idea of advertising or promoting ourselves is distasteful. Some of us have been taught we're not supposed to "toot our own horns." But there's a difference between inflated bragging and honestly telling people the benefits of our work.
We can change our view of advertising by thinking of it as education: letting prospective clients know what's available and how it might help them. No need to feel like used car salesmen -- when we educate the public about our work, we are teachers.
Help with Money Awareness
To become comfortable with running a small business, we need a better understanding of our own attitudes about money. Reading a book or hearing rules or suggestions about money isn't usually enough help. Some massage school business classes use role-playing in various situations as a way to unearth our real feelings about money. For instance, role-playing telling a reluctant client he owes for canceling without enough notice would be useful. Also, having mentors who are clear in their relationship to money can be a major help with business issues. Peer group discussions can be supportive because everyone has money and practice issues, but generally in different areas. In a group, others will have clarity about issues with which we struggle. Personal supervision can also aid us in getting to the deeper issues we have about money.
Some manual therapists are starting to use "coaches" -- individuals specifically trained to help practitioners create business goals which suit their values. A coach can help us figure out the steps to reach those goals and then, like a personal exercise trainer, hold us accountable each week for making progress.
There are also workshops which specialize in getting to the bottom of our attitudes about money. To find a good workshop or coach, we can look for a well-recommended one that has made a beneficial change in the financial attitudes of someone we know.
Getting More Comfortable with Money
Both personally and as a group, manual therapists' issues about money are sometimes rooted in insecurity about our professional worth. Most of us don't have backgrounds as "captains of industry" -- in fact, many of us are suspicious of anything that smacks of big business. We can be naive or mistrustful about money.
Our work isn't an easy way to make a living and we need all the help we can get. By exchanging ideas with colleagues, mentors and people who have been successful in business, we can educate ourselves and find what works for us. As we become more conscious about our relationship to money, the financial aspect of our work can be more satisfying.
The ability to set good money boundaries is a crucial part of our work. Clients need the comfort and safety of a clear financial relationship, and so do we. Keeping clean and clear about money is, like most boundary issues, a skill and an art we will practice and improve throughout our careers.
Nina McIntosh, MSW, combines 20 years as a bodyworker -- first as a massage therapist and later as a certified Rolfer -- with her previous experience as a psychiatric social worker. She currently practices as a Rolfer and is also a Rosen Method Bodywork intern. McIntosh's book, The Educated Heart, can be purchased at Decatur Bainbridge Press, 877/327-0600, www.educatedheart.com.
Copyright 2003. Associated Bodywork and Massage Professionals. All rights reserved.
Many of us have an uneasy relationship with business finances. We feel awkward going from being the "Caring One" when a client is on the table, to being the "Cashier" at the end of the session who says, "Now gimme' 60 bucks." We feel a little guilty about money.
A bodyworker said recently, "I'm not in this for the money. This work is like a calling for me." For those with that attitude, there's often an accompanying anti-money sentiment. There's nothing wrong with wanting to make the world better, but there's no need to feel awkward or guilty about money either. Part of what professional means, after all, is that this is how we pay the rent. Charging appropriate fees tells a client we're serious about our work.
Massage school directors report that students generally have a hard time charging for their work. New practitioners feel uncomfortable because they think they're charging people for nurturing them or caring about them. A colleague has this advice: "Tell them clients are paying for their time. The caring is free."
The Case for Money
Actually, the exchange of money is part of what makes clients feel safe. Money clarifies clients' obligations to us and ours to them. The exchange of money helps clients feel comfortable with receiving what we give them. They know what they owe us in return. Money is clean, it's precise, it's simple. It balances the relationship.
Paying for services is an important part of the client's healing process, not an unpleasant bit of reality we tack onto the "real" healing process. Throughout the world, fees are an intrinsic aspect of healing. Jerome Frank studied many kinds of health care providers -- witch doctors, traditional Western medical doctors and alternative health practitioners. In Persuasion and Healing, he describes the ways an effective therapeutic experience involves the patient/client making a sacrifice. In cultures other than our own, the sacrifice might be a nice fat chicken. In ours, it's usually money.
The idea of the healing value of sacrifice doesn't justify greed or over-charging, but the concept can help us feel more comfortable with collecting appropriate fees. The element of sacrifice may give clients a deeper sense of the treatment's value and help them benefit from it. Many manual therapists have discovered that clients who are given a "special deal" or who are undercharged never seem to get as much out of the work as those who pay full price.
The exchange of money provides clarity, it's part of a safe professional environment. It validates both practitioner and client. The giving and receiving of money speaks deeply to us about our worth and the value of our work. For clients, it's a tangible sign of how much they will invest in their own well-being.
Different Modes
The part of us that empathizes with clients and the part of us that makes budgets and deals with money are two different aspects of our personalities. Sometimes it can feel awkward to make a transition between the two. Doctors and people who do volume business resolve the conflict by having another person, an office manager, handle the finances. But most of us are stuck with the dilemma of sliding back and forth between Caring One and Cashier.
We've just finished a session in which we felt touched by a client's revelation of the pain he feels in his life, and we're feeling compassionate toward him. As he gets ready to pay, he says, "Oh, do you mind if I post-date this check for next week?" Or, "Gee, I forgot my checkbook. Mind if I pay you next time?" How do we then say, "I prefer that you pay me at the end of each session," without feeling callous? Much easier to say "Oh, sure...that's fine," even if it really isn't fine.
The majority of us don't come to this work with a business background. We spend much of our time in school learning our trade, not learning how to sell ourselves and collect our fees. To move past any blocks we might have, we have to put extra energy into educating ourselves through mentors, classes and supervision.
Money and Sex
Money is like sex -- we talk about it all the time, but rarely do we talk about it honestly or openly. When openness is lacking, we don't realize others are struggling with the same issues. We don't learn from each other's mistakes and we can't support each other.
Is there a practitioner who has had perfect judgment about the financial part of the business...and do we even know what "perfect" would look like? Is there anyone who hasn't backed down from charging a client for an appointment canceled at the last minute, who hasn't given a special discount that backfired or who hasn't ever under- or overcharged?
Money is also like sex in that it brings up strong feelings. Many of us have old, unexamined ideas that get in the way of our judgment. We might have deep feelings about whether money is "good" or "bad," or whether we are competent with it. We might have unrealistic ideas about how hard or easy it is to make a living. Also, we have to come to terms with cultural values that measure personal worth by one's bank account. Working in a profession that usually doesn't make us rich, we have to learn to value our work even if we probably won't become millionaires (or even close).
Money is also like sex in that we can lose clients very quickly if they misunderstand our intentions or we become careless about boundaries. For instance, suddenly changing fees without notice can be jolting to a client, as can charging for a missed appointment without having explained our policy at the outset.
Because we have strong feelings about money, there's all the more reason to talk about it -- with a mentor or with a support group of peers. And all the more reason to be clear with ourselves and our clients about financial policies. Because we can be swayed by strong feelings, we want to stick with our policies unless we have a carefully thought-out reason to make an exception.
What to Charge?
Starting a practice, most of us can judge what the going rate is for our brand of manual therapy at our level of experience by researching the fees other manual therapists charge. All the same, we still want to give careful thought to what we charge. Our rates affect what both clients and colleagues will think about us.
If we charge more than the norm, some clients may be put off, while others may think we must be offering something special to be charging extra. If we charge less than the going rate, some may be attracted to the bargain, but they may not value the work as much.
If we charge a good deal (maybe $20) over or under what others are charging, we run the risk of alienating our colleagues. Sometimes even $10 a session over or under can set a practitioner apart. Colleagues may feel we're arrogant if we charge more than they do without having more training or experience. They may feel we are undercutting them if we charge less than the usual fee. Mostly, we want to settle on an amount with which we feel comfortable. If we're not comfortable, people will sense it.
Talking to Clients About Money
When we talk with clients about money policies, our attitude and tone make a world of difference. We want to sound straightforward, business-like and confident -- not apologetic or punitive. For instance, if we have to let clients know we are charging them for a missed appointment, we can simply say, "As you know, I charge full fee for a missed appointment." Of course, we want to make sure they know from the beginning what our policies are.
Clients want to go to practitioners who are confident. If we give notice we will be raising our fees, for instance, we don't need to sound apologetic. As a colleague said, "We don't need to send clients a sympathy card when we raise our fees." Tone makes all the difference.
The Perils of the Special Deal
What about giving discounts or using sliding scales? Most of the people I interviewed found it works best to stick with one fee -- with rare and well-thought-out exceptions.
The money arena is one in which we're likely to feel tempted to make special exceptions for clients. Making exceptions occasionally works out and is appropriate, most of the time, it's a mistake and a sign of deeper problems. We want to treat each client as a unique person, but we can run into trouble when we start bending money boundaries.
When we give a discount or use a sliding scale, we're automatically creating a dual relationship. We become the client's banker -- involving ourselves in his finances. As practitioners, we shouldn't be concerned with how much or how little money a client has. Dual relationships create complications that can interfere with our ability to put our heart into our work.
Imagine this scenario: A client has convinced you that, as a student, she can't afford your full fee. You have agreed to accept $40 per session instead of your usual $60 fee. After you've seen her for a month or two, she tells you she can't make the next week's regular appointment because she's taking a vacation to Hawaii. How do you feel?
Or the same client comes in after a month or two and complains she's not getting enough from the work, that she doesn't feel as good as she wants to. Are you able to handle this complaint with the same objectivity you would if she were a full-fee client? Or do you judge her as ungrateful?
Sometimes schools or individuals give discounts to groups of people, such as students, people with life-threatening illnesses, or spiritual/religious teachers and ministers. A special fee can work well if it's motivated by our hearts or our convictions and not by guilt. When we make such an exception, we need to keep checking in to make sure our hearts are still in it and our bank balances aren't suffering.
Even when we do pro bono (no fee) work or discounted work that seems purely altruistic, we want to look at the difficulties that may be hidden in such relationships. Good questions to ask ourselves any time we consider reducing fees are:
- Do we have a standard policy for fee reduction and are we veering from that policy?
- Are we uncomfortable with saying "no" to this client?
- How do we decide how much discount to give?
- Is there any way we foresee coming to resent or regret the arrangement or wish it were different? Will we feel owed?
- What are the possibilities the special arrangement will harm the therapeutic relationship?
By not carelessly making special deals, we protect both ourselves and our clients. The special financial arrangements we make for clients often don't help them. When we go outside the usual fee structure, it can confuse clients: they can end up feeling uncertain what their obligation to us is. They also may wonder if we can adequately provide a safe, consistent environment or if we will continue to change the boundaries.
When a session is free or at a reduced rate, we need to be especially careful with other boundaries. It would be confusing to a reduced-fee client, for instance, to also allow him to come in twenty minutes late for a session. (It would be confusing to anyone but especially for someone for whom we are already bending boundaries in other ways.) Such allowances can also create resentment in us.
Sometimes there's a bit of an unhealthy "rescue" attitude in a special deal. In an unhealthy "rescue," we, usually unconsciously, treat the client as if he were in some way inadequate and therefore, not able to be held to normal business arrangements. Sometimes clients attempt to manipulate us into such thinking. Sometimes, we may think giving a client a special deal shows our compassion. All of these motivations are different from making an adult-to-adult business arrangement with someone who has a legitimate reason to need a discount. Unhealthy rescues always backfire. When we depart from our normal framework, we encourage clients to do so.
A colleague reports: "After I made a special payment arrangement for a client who said he was down on his luck, he missed two appointments without giving me notice. After we were finished with our work, I had a hard time collecting what he owed me."
It would be difficult to make blanket statements about when it is appropriate to give a discount. Some practitioners can handle giving discounts and making special arrangements more easily than others. We have to know our own limitations and biases about money. The bottom line is whether the arrangement could be harmful to either us or the client.
Missed Appointments
You've arranged your life to see a new client at 3 p.m. You're not at the movie, you're not taking a nap, you're not hanging out with your buddies. You have kept that slot open for that client and you're all prepared: you've warmed up the room, put clean sheets on the table. Maybe you were counting on the money and you've already mentally spent the $50. And what happens? No show. No phone messages to explain....nothing. The missed appointment is that dreadful thud in the professional life of a manual therapist.
Along with the dreadful thud goes the pesky question of whether to ask the client to pay for the missed session. Most manual therapists usually charge for a missed appointment unless there's been an emergency. But what constitutes an authentic emergency is a judgment call. Illness rarely comes on suddenly. Cars don't often just stop working. Traffic is usually predictable. Sometimes no-show clients can't anticipate problems, but often they can.
Many of the manual therapists I interviewed were flexible about missed appointments, for instance, some don't charge the first time a client misses. However, standard practice is to charge full or partial fee for a no-show. Some practitioners -- especially new ones -- find it hard to ask a client to pay for a missed appointment. They feel awkward asking payment for "doing nothing." The point is that the practitioner could have booked another client in that slot. It's time and money lost.
If the no-show client doesn't call to explain or to make another appointment and won't return our calls, obviously we can't do anything about it. Such a client probably wouldn't respond to a written bill either. Sometimes practitioners are concerned about making the client angry, so they rationalize that they wouldn't have filled the vacancy anyway. Nevertheless, do we really want to work with a client who doesn't respect our time? If we feel angry with a client for missing appointments without notice, can we be compassionate when we work with her?
Sticking to our guns about charging for missed appointments shows we value our time as professionals. In this instance, maintaining boundaries protects us and helps us feel safe. The flip side is that we show clients the same courtesy, letting them know if we have to cancel their appointments without 24 hours notice, they will receive a free or discounted session.
Even with a firm policy that has been communicated to clients, we will always have an occasional no-show. I've had no-shows from clients who have heard my policy twice as part of a standard orientation and who have also signed a written agreement. Here are some suggestions to make missed appointments less frequent:
- When clients make their first appointments, always tell them they will be charged for appointments canceled without 24 hours (or whatever we think is adequate) cancellation notice.
- Have clients sign an agreement to that effect the first time we see them. Even if we are sure we have told them, they may not remember we did.
- Tell unreliable clients they need to call us by a certain time the day before the session to confirm the appointment or we will fill that time slot with someone else.
Refunds
It's often wise to offer an unhappy client a refund or partial refund even if there has been no negligence or harm on the part of the practitioner. If a client is upset enough to want fees refunded, we're generally better off giving the money back. Practitioners may want to consult a lawyer about how best to handle a specific situation.
If a client is harmed or neglected during our work with him -- whether or not we were totally responsible -- then we want to make it up to the client.
A woman had received four sessions from a bodyworker. The fifth one was 20 minutes shorter than the others and the quality of the work seemed below the previous quality. After leaving his office, she realized she felt short-changed and called the bodyworker, explaining what she had noticed. He told her she was right -- he had been on the verge of catching the flu when he worked with her. He didn't apologize or offer a refund or discount on another session. The client never went back to him and didn't refer anyone else to him.
This example doesn't mean that whenever we feel we have performed less than our best, we should rush to offer a free session. Those who are self-critical would be constantly offering free sessions. It does mean that when a client feels short-changed and has reason to feel that way, we want to make it up to him. Regardless of whether we had control over the situation that caused a client's discomfort, not charging full fee or refunding our fee is the smart thing to do if we want to continue seeing the client. An example of this is a massage therapist who charged a client for only half a session when the last 10 minutes of the hour were disrupted by the loud barking of the neighbor's dog. (Although we may not be able to control the neighbor's dog, it's our responsibility to provide a quiet environment for the session.)
Advertising
Manual therapists are essentially running a small business and small businesses advertise. Many of us don't have previous experience in business or as entrepreneurs. We may be uncomfortable with basic business practices and feel the idea of advertising or promoting ourselves is distasteful. Some of us have been taught we're not supposed to "toot our own horns." But there's a difference between inflated bragging and honestly telling people the benefits of our work.
We can change our view of advertising by thinking of it as education: letting prospective clients know what's available and how it might help them. No need to feel like used car salesmen -- when we educate the public about our work, we are teachers.
Help with Money Awareness
To become comfortable with running a small business, we need a better understanding of our own attitudes about money. Reading a book or hearing rules or suggestions about money isn't usually enough help. Some massage school business classes use role-playing in various situations as a way to unearth our real feelings about money. For instance, role-playing telling a reluctant client he owes for canceling without enough notice would be useful. Also, having mentors who are clear in their relationship to money can be a major help with business issues. Peer group discussions can be supportive because everyone has money and practice issues, but generally in different areas. In a group, others will have clarity about issues with which we struggle. Personal supervision can also aid us in getting to the deeper issues we have about money.
Some manual therapists are starting to use "coaches" -- individuals specifically trained to help practitioners create business goals which suit their values. A coach can help us figure out the steps to reach those goals and then, like a personal exercise trainer, hold us accountable each week for making progress.
There are also workshops which specialize in getting to the bottom of our attitudes about money. To find a good workshop or coach, we can look for a well-recommended one that has made a beneficial change in the financial attitudes of someone we know.
Getting More Comfortable with Money
Both personally and as a group, manual therapists' issues about money are sometimes rooted in insecurity about our professional worth. Most of us don't have backgrounds as "captains of industry" -- in fact, many of us are suspicious of anything that smacks of big business. We can be naive or mistrustful about money.
Our work isn't an easy way to make a living and we need all the help we can get. By exchanging ideas with colleagues, mentors and people who have been successful in business, we can educate ourselves and find what works for us. As we become more conscious about our relationship to money, the financial aspect of our work can be more satisfying.
The ability to set good money boundaries is a crucial part of our work. Clients need the comfort and safety of a clear financial relationship, and so do we. Keeping clean and clear about money is, like most boundary issues, a skill and an art we will practice and improve throughout our careers.
Nina McIntosh, MSW, combines 20 years as a bodyworker -- first as a massage therapist and later as a certified Rolfer -- with her previous experience as a psychiatric social worker. She currently practices as a Rolfer and is also a Rosen Method Bodywork intern. McIntosh's book, The Educated Heart, can be purchased at Decatur Bainbridge Press, 877/327-0600, www.educatedheart.com.
