Managing a massage therapy practice can be challenging; especially when some, or all, of your therapists are independent workers that get paid by appointment.

To confuse matters further, each therapist has their personal schedule, and often a schedule at another clinic or spa to accommodate.

So how do you ensure your business runs smoothly under these awkward conditions all while being professional in the eye of the customer?

Luckily, there are a wide range of cloud-based software applications that can help you manage your massage clinic more efficiently, and boost results. In particular, online scheduling applications have tons of useful features that streamline the appointment booking process between you, your receptionist, and your Massage Therapists.

Here’s a list of 4 pain points commonly faced by massage clinic owners and things you should look for when choosing a scheduling application.

1. Managing Your Therapists Sporadic Schedules

Massage therapists are frequently hired as independent contractors on an appointment basis and only come in when they are booked.

As you may not be able to provide them with enough appointments, often times they will also work for themselves and/or another massage practice. Knowing when they are available to work can be an overwhelming task.

Do any of these situations sound familiar?

• The therapist isn’t actually available on the given date and time, you must then scramble to find another therapist to fill the already booked appointment.
• You may have no choice but to call back the client and embarrassingly ask to reschedule the appointment if he or she absolutely wanted the specific therapist or you cannot find a therapist for that slot.
• The therapist may just, not show up if there is a conflict in his or her schedule that you were not aware of.

Making sure you know if and when a therapist is available to work is essential.

Many scheduling applications allow you to configure a regular, recurring weekly staff schedule.

However, you should also inquire whether it is possible to program irregular and/or upcoming schedules.

It is also a huge time saver if therapists can update their own schedules through their unique user login for last minute changes to specific calendar dates.

2. Educating Your Therapists About the Client While Protecting Your Client List

From talking to massage therapy business owners, it is clear that protecting client data is a tremendous concern as therapists need to easily access data to better serve clients.

However, depending on the employment relationship, (and depending on rules and regulations with your specific college) therapists may not have the right to solicit clients post employment and/or automatically walk out with client files.

You can therefore take steps to ensure therapists don’t just leave with your entire client list including phone numbers and e-mail addresses.

Even when therapists are not employees, you can protect data and ensure confidentiality of personal information by limiting access to their patients only – not the entire clinic’s database (again, depending on rules and regulations in your area).

Some features to look for in a software that help protect your client data:

• Make sure you can create different types of users with different levels of access and privileges.
• Absolutely make sure only administrators can export your client database.
• If allowing therapists to book their own appointments, see if you can limit client database access to their clients only.
• See if you can also hide client info like telephone numbers and e-mail addresses.
• Verify if there are any logs available to track general user actiity.

And DO NOT SHARE YOUR ACCOUNT OWNER ACCESS with any of your staff.

Take the time to create an additional profile for your receptionists and therapists. This makes it easier to terminate access to your client data when someone leaves.

3. Enabling Therapists to Manage Their Own Appointments

If you own a multi-practice clinic whose main services are not massage therapy, but still want to offer massage therapy as an added service without adding to your administrative workload, then empowering your therapists as much as possible can save you a lot of time and make you more money.

Many software applications with different user types include a profile that allows the therapist to book, cancel and/or modify appointments for themselves.

This enables the therapist to fully manage his/her schedule and appointments securely while allowing you to still oversee everything.

In addition, why not encourage a therapist to book the client’s next appointment after their massage treatment has been completed by using a tablet connected to your cloud-based software application.

Photo by: FirmBee

4. Reducing No-Shows

No-shows are another major issue for any massage therapy business as this leads to lost revenue and idle time for your therapists.

The no-show rate can easily be reduced by implementing a software application that sends out automated appointment reminders.

It is incredible how a simple e-mail or text message reminder sent out a couple of days before the appointment allows clients to inform you in a timely manner of changes to their availability and eliminates forgotten appointments.

Also, stop wasting time calling all your clients to confirm their appointment as many people of today’s generation do not even answer their phone calls.

Instead find a system that lets clients confirm their appointments themselves either by e-mail or text message. Automating appointment confirmations is a great feature giving you and your therapists the certainty that your client will be attending his/her appointment with minimal to no intervention on your part.

Other features that can reduce no-shows include asking for a credit card number or deposit at the time of the booking. If people know they will lose money, they will think twice about skipping out on their appointment.

All in all, if you are still using paper or an outdated software application, look into a web-based appointment booking system. This will allow you to run your business more efficiently and stay connected with your therapists. The entire team will be happier and experience fewer administrative frustrations. Even Massage Therapists need less stress in their lives.

I took this amazing course on communication a few years back and I have never forgotten the first thing the gentleman said… you don’t really listen now, you never have and you probably never will.

Wow what a harsh way to start a communication course, but in a sense and for the most part it’s true.

But when I learned all the things that were preventing me from really listening, I actually started to hear more clearly what the people in my life were trying to say and sometimes I really noticed the things that were missing in the conversation.

It’s been said, and I believe it to be true, that most of communication is in the listening.

Now in order to really understand this statement we need to include not only the words being said but also the tone of voice, the pitch and rhythm and although it may be controversial in some circles I believe real listening requires visual cues like body language, posture and the physical response to questions especially when you are looking at communication from the therapist – patient relationship.

To really understand what our patients are trying to communicate we first need to understand how (in the context of communication) the majority of the message is relayed by the patient.

Remember that different experts break down things in different ways so the exact numbers may be slightly different but the idea is very similar.

We can break it down like this

– Only 7% of the total message is found in the words

– Up to 38% of is in the paralanguage (this is the pitch, tone and rhythm of the voice)

– The remaining 55% of the message is found in the body language (mostly facial expressions)

Now this does not mean we should ignore the words, it just means, to get the full picture we must be present and pay attention to a number of different cues while our patients are talking.

Blocks To Listening

Are you really listening to the other person when you already have an opinion about the person?

It’s kind of like looking at life through rose colored glasses.

We have so many opinions and preconceived notions about how things are and how people are that it completely invades our listening and hence how we relate to other people.

Some of the blocks to listening:

• Mind reading: assumptions do not help us hear what the other person is actually saying, they are self-confirming beliefs.
• Judging: Do I agree, do I disagree with what this person is saying are they right or wrong… these thoughts pull you away from listening they don’t help you hear what the person is saying.
• Identifying: This is when you relate the speaker’s story to something similar in your life. This is a block to listening because you are not actually listening to their story so you may miss important details that are not in your story.
• Filtering: This is only listening to the parts of the story that resonate with you and skipping over the parts that don’t.
• Placating: Bypassing the tough parts of the conversation or saying things like “at least they passed at home or they are no longer in pain”… this is what we sometime do, not for the speaker but for ourselves to avoid our discomfort.
• Advising: Thinking about advice we can give to help the person while they are talking is noble, but it can take us away from listening to what is actually being said.

These are just a few of the blocks to listening, there are many more.

But if you look honestly, you may see yourself in a few of these examples.

It is not bad and wrong to do these things, it’s just not an effective way of listening to other people.

Pseudo Listening

Pseudo listening is basically pretending to listen but not really listening to what the other person is trying to say.

The intention is NOT to listen, but to have some other needs met.

I know I am guilty of this from to time in my personal life and it has even entered my professional life occasionally.

This is something to be aware of, because only when we are consciously aware of something we have the opportunity to shift.

Some of the reasons we may be pseudo listening:

• Sometimes we just want to be liked, so we try to give the appearance of listening intently.
• In social situations we may be checking for signs of rejection.
• With a spouse or an adversary we could be hunting for a specific piece of information.
• Sometimes we are buying time  or rehearsing our response.
• From time it is  Quid Pro Quo I am listening to you, so you will be listened to.
• During arguments we may be listening for weak points; gathering ammunition.
• Trying to be or look  good or nice.
• Sometimes it’s as simple as not knowing how to leave without offending.

Think about the times you are doing this, were you really listening to the other person or were you so distracted by your own thoughts and motives that you completely missed what the other person was trying to say?

Real Listening

So what, you may ask, is real listening?

The Messages Workbook (a text we used to use in PD100), says that being quiet when someone talks does not constitute REAL LISTENING.

REAL LISTENING is based on the intention to do one of the four following things:

• Understand someone.
• To enjoy someone.
• To learn something.
• To give help or solace.

Intention has a big role to play in real listening, when you get out of the way, listen and watch the person in front of you listening will come easy.

Active Listening

In order to not only hear what the person is saying but also let them know you heard and understood what they said. You can use a three step process called active listening.

1 Paraphrasing

Paraphrasing is simply repeating what you heard back to your patient, but in your words.

In other words ….

So basically how you felt was…

Did you mean…?

Paraphrasing should be used any time your patients say something of importance about their pain, accident, injury etc.

2 Clarifying

We use clarifying to make sure we have understood not only what the person said but also the context.

When we take the time to clarify we show our patients that we want to fully understand the communication, we understand the impact of the situation and we are willing to put in the work to fully know and understand the person and the impact the condition is having on them.

3 Feedback

When we understand what has been said and we have clarified that we understand the context we can now give feedback.

This can be in the form of a treatment plan, a referral to another healthcare professional when the issue is out of our scope, or it may be reminding someone that compliance to home care is vital to the treatment plan.

Listening With Openness

Have you ever heard the phrase “ looking at the world through rose colored glasses”?

I have always believed that this points to the fact that we all have some idea of the way things should be.

This is right and that is wrong, this is good and that is bad.

All of these strong beliefs, thoughts and opinions change the way we listen to others. In fact, when we come from this place we are not really listening to the other person, we are just listing to our own opinion of what the other person is saying.

To really listen to other people we need to stop “shoulding” on ourselves and others, let go of our personal opinions and really objectively listen to what the other person is saying.

Photo by: Unsplash

Listening With Empathy

When I teach this type of listening at VCMT I usually feel like I am preaching to the choir.

I really believe that the vast majority of people who have entered the massage therapy profession have done so as an expression of the empathy and compassion they already have.

Listening with empathy comes from an understanding that people, for the most part, are just doing their best to survive and all the crazy things they do are an expression of this.

I remember a few years back when a patient came into my office in severe pain, very short and almost angry.

He kept saying get me on the table we don’t have to do all this other stuff. I realized this man was just in pain and he really did not mean to be rude or short. I calmly explained that the interview and special testing was necessary to determine the approach I would be taking with the treatment and that the better I understood exactly what was causing the pain the more effective I could be in treating him.

To make a long story short, the treatment went quite wall and the man could not shake my hand enough at the end of the treatment.

Remember, no matter what the patient is expressing, its not personal.

People in pain can sometimes say things they don’t mean. Always come from a place of understanding, a place of empathy. Try to put yourself in their shoes, how would you feel if you were on the other side of the room? How would you want to be listened to and treated? I always tell my students that true success is not just about being the best technical Massage Therapist. True success is becoming a well rounded therapist with excellent communication, listening, knowledge and technical skills. I believe that a present compassionate therapist will achieve measurably better outcomes with all their patients.

Sometimes I just have to shake my head.

I’m sure we’ve all heard the same kind of things in our clinics when patients go to other practitioners.

“I have compressed discs in my spine, I’m out 14 degrees here, 12 degrees here and 8 degrees here”

Yeah, I probably have all that too, but I’m not in any pain. 

“I went to this other therapist, and they said I’d probably never get better”

Well that’s not true.

Then there’s my favourite (I wish there was a sarcasm font).

“Well the muscle pain you’re having stems from something that happened when you were a child, it’s going to be really hard to get rid of it”

I’m sorry about whatever it is that happened, but that is going to take some counseling to help, you should talk to your doctor about a referral to a mental health professional to get the appropriate care.

Sometimes I wanna phone up these other practitioners and ask what the hell they are doing saying things like that to a patient but apparently I’m supposed to be professional or something. 

Instilling Beliefs In Patients

As therapists we play a role in which we can be either effective or detrimental.

There is a strong correlation where what we say to a patient has a huge impact on their improvement or just instilling fear that makes them have to keep coming back in for more therapy.

Unfortunately instilling fear in patients with the language we use has become more of a marketing gimmick than using our words to help a patient. 

This is called the “Fear Avoidance Model”.

The fear avoidance model shows that patients can develop pain as a result of fear and avoidance behaviour. Typically it is referring to a patients fear of movement as it might cause pain.

However studies have shown how this model can be developed in other ways.

If a patient can’t make sense of the pain (which is part of our job to explain to them), have some societal beliefs associated with past experience or have a diagnosis of something that can’t be fixed are all things that can be associated with this fear avoidance model. 

If a patient comes in for treatment and already has some of these underlying issues, we have the opportunity to either correct or reinforce what is going on with them. 

We can have a strong influence on those patients beliefs and in turn can influence those beliefs in a positive (or negative) way.

If we decide (and it is a decision on our part) to use negative language like “tissue damage, out of alignment, or structural problems” we can change a patients beliefs for many years to come. One study showed that it can even lead to feelings of increased vigilance, guilt and worry.

The same study showed that if we take an approach of providing reassurance, which increased confidence we could positively influence a patients movement and activity.

So, imagine if just the way you communicated with your patients, made them want to adhere to their home care and gave greater outcomes overall in their treatment?

Photo by: PublicDomainPictures

Improving Communication For Better Outcomes

So where do we go from here?

We are always going to have other therapists and practitioners who use scare methods like I mentioned at the beginning.

I’m pretty sure a little piece of me dies inside whenever a patient tells me about these things they’ve been told. 

In the case of the patient saying they have compressed discs and are out of alignment, well I’m pretty sure if they x-ray’d me they would find the same thing however I’m not in any pain. In fact Todd Hargrove wrote a great article on the topic that we have used on this site, which you can read here and is a good reference to show a patient when they are worried about imaging and disc issues.

The way we communicate has to involve positive reinforcement, with good explanations of what is going on with the patient.

Being able to describe to them that pain is just the nervous system reacting, not tissue damage, is a hell of a lot better than reinforcing some old beliefs or scare tactics.

There is a new model of rehab being developed that outlines four elements that could lead to better outcomes:

1. Knowing the person and building a supportive relationship
2. Effective education and information exchange
3. Goal setting and action planning
4. Fostering positive, realistic, cognitive and self framing.

Those four steps represent a golden opportunity for us as Massage Therapists. 

All four steps are well within our scope of practice and we quite frankly have the opportunity to reinforce those steps more than any other practitioner due to the time we get to spend with patients. Because we get to spend so much time with our patients our ability to build that supportive relationship is paramount to what we do.

Even being able to read the mood of our patient who we have built that relationship with can make a difference in the outcomes of their therapy.

As much as the terms “evidence based”, or “research based practice” gets thrown around (I know some of you don’t like it), there is sound justification to making this a part of your practice. Research is actually showing us the importance of how we communicate with our patients. There is even studies that show how contextual factors like a therapist and patients features can contribute to outcomes. Now I know there is no way you can do anything about your features, but you can do something about all the other things we discussed. Staying up to date on new research, working on communication skills and not being afraid to “forget” some of the things we used to know goes a long way to establishing ourselves as the more trusted source of therapy in our communities. Being able to educate a patient when they come in, helps to build that supportive relationship and puts you at the forefront of their healthcare as a professional. Help your patients to set goals aligned with their home care by making them positive and realistic. Our biggest job is always going to be education. Educating our patients and explaining what is happening to them is a key factor in getting them back to their activities of daily living. Unfortunately as other practitioners use fear to market their practice, they make our jobs just a little bit tougher.