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Concerns and Employment Considerations
As the spa industry continues to grow, so do the employment opportunities for massage practitioners. In the past most practitioners worked part-time at spas to augment their private practices. This has been shifting with many practitioners now working solely at spas.
I interviewed numerous therapists and spa directors representing a wide variety of settings from holistic wellness centers to posh pampering resorts to casual day spas. While most of the major ethical concerns of working in a spa are similar to those in any type of practice, the spa environment contributes additional twists. The areas of greatest concern from where ethical dilemmas arise are: expectations outside the actual treatment service; boundaries; safety; sexual misconduct; inappropriate touch; standards of practice; working outside the scope of practice; health issues not addressed; compensation; confidentiality; lack of autonomy; client/practitioner interactions; practitioner/staff interactions; marketing; and the overall way management treats the practitioners.
Before hiring at a spa, determine if it attracts the type of clients you want and allows you to work at a comfortable pace and style. Spa employment often requires conforming to a set image and structuring your treatments to align with the spa's schedule, policies and philosophy. Consider the people who frequent these establishments, the kinds of services they require and how they expect to be treated.
Types of Ethical Issues
General Business Practices
The requirements in terms of the practitioners' attire, interactions and skills vary with the environment. Some spas ask practitioners to expand their skills to perform other services (e.g., hydrotherapy, wraps and paraffin treatments) when not doing their primary service. The expectations surrounding what you do when not working with a client depend upon the company philosophy and your employment status. Some facilities expect practitioners to assist wherever they are needed-from greeting clients to cleaning. Indeed, these expectations may be present even when practitioners are not paid for non-client interactions.
Some spas provide excellent training and others expect the practitioner to jump right in. One therapist relates how she was the first therapist hired at a new day spa. Not only was she the sole practitioner, she had no supervisor, nobody to train her and no resources. She shared, "There were no client policies (at least none available to me) and no place to put files or keep records. I pretty much did whatever I wanted. Luckily, I have a reasonable amount of marketing sense, had run my own business, and am both professional and ethical. A graduate fresh out of school would have been completely lost."
Perhaps a therapist's confidence in his or her massage abilities gives off an impression of being competent in all areas and so a spa director may simply assume that the practitioner can fit right in, as is reflected in the following example:
I was fresh out of school and working successfully in private practice, but curious about other ways of doing this work. I had a friend who was working at a well known luxury spa in the area. He was heading off for an extended vacation and was looking for people to cover his shifts while he was gone.
I saw this as a means to get on the substitute list and eventually work my way into permanent employment there. So I agreed to cover some of his shifts. I tried to contact the spa manager many times before the first day I was supposed to work. The spa is part of a fancy hotel so I would actually be considered an employee of the hotel. About two weeks before I was to start I was instructed to go to the hotel to fill out paper work. I thought I would finally be getting the orientation to the spa I'd been asking for but instead got a two-hour paperwork session with someone from hotel's Human Resources Department and a brief tour of the entire hotel, with only a nod to the entrance of the actual spa. I continued to try to reach the manager of the spa, feeling ill-prepared at this point to start. I was finally told to arrive 1.5 hours early on my first day and someone would train me then.
I showed up as I was told and found only the receptionist there. She showed me what she could, (which wasn't much), mostly where the uniforms were kept, which room I'd be working in and how I could tell which client had been booked for me. I sat around awhile until another therapist showed up and begged her for help in setting up the room, which involved many elements I hadn't yet had opportunity to use yet, like hot stones. I also wanted to understand the basics of the space that help the therapist and client feel comfortable such as knowing how the lighting and music system work. She helped me as much as she could but was needing to set up her own space. So, in the end all the orientation or training I got was about 15 minutes on my first day of work. I was feeling awfully ill-prepared.
I worked on four people that day, three of whom wanted a hot stone massage. I had difficulty finding half my clients in the maze of rooms. The worst moment was coming out halfway through the day to find another therapist waiting for me to tell me we had a double massage, something I'd never heard of, let alone been warned would be a part of my first day. Couples could book two therapists in one room and get massages side by side. I hadn't been in the same room with another therapist working at the same time since school and had never felt the need to coordinate with someone, let alone a therapist I'd never met before. It was very awkward. Especially as she had worked with the husband before and had established rapport with him. I had never met either the wife or husband and had no preparation for the set up. I had no idea if we were supposed to be working in the same way, so spent the hour awkwardly trying to mimic what the other therapist was doing and feeling uncomfortable listening to their conversation.
That day was one of the few times I have ever felt more like a servant than a health care therapist. It wasn't the style of work I prefer to do, so part of the responsibility is certainly mine. But I feel that the atmosphere created by the spa certainly supported that attitude.
I finally met the manager of the spa sometime that afternoon. She never acknowledged all the messages I'd left for her or explained why she hadn't scheduled time for me to train. I was called several times to sub after that experience, but had felt such a lack of support that I had no interest in working there again. I was paid $40 dollars per massage out of the $110 per hour fee they charged the clients. I decided I preferred working for myself in a supportive atmosphere with clients who were more interested in participating in their care than paying exorbitant amounts for ambience.
Training issues are not limited to orientation. Several therapists mentioned that staff practitioners were expected to teach copyrighted body treatments and sequences to the other practitioners, even though this action breaks the agreement between the owner of the treatment and the practitioner. After years of behavior like this one large day spa eventually designed its own treatments. Other spas are responsible and hire professional trainers to facilitate workshops on products, treatments, and other types of continuing education including topics such as sexual harassment and non-violent communication.
A related business practice that is not necessarily an ethical issue--although it could turn into one-is sanitation. I heard several stories of how during peak seasons, practitioners were told to turn sheets over and reuse instead of putting on fresh sheets. Sometimes the sanitation concerns are as simple as not having trash cans in the rooms for client's tissues (and the therapist having to pick them up). One therapist relates the following, "There was an issue with hot stone sanitation. Practitioners were expected to reuse the stones as necessary throughout the day without sanitizing them. After enough complaints from the practitioners management finally researched a system to keep the stones in chlorinated water. It was better but then some people objected to the chemicals."
The major area of ethical concern is not so much about the amount of money therapists are paid (which is more of a morals and values issue), but rather how a therapist is classified. Many practitioners are hired as independent contractors when for all intents and purposes, they are employees. Most practitioners working in a spa would be classified as employees.
The IRS has developed a list of 20 factors that they use to determine the status of employee or independent contractor. The degree of importance of each factor varies according to the profession and the conditions in which the services are performed. The most important factor is control.
If the business owner has the right to control how and when a person works, that person is most likely an employee. If you have an employer-employee relationship, it makes no difference how it's described. It doesn't matter if the employee is called an employee, associate, partner or independent contractor. It also doesn't matter how the payments are measured, made or what they are called. Nor does it matter whether the individual is employed full-time or part-time.
The other financial aspect where unethical-and illegal-behavior can occur relates to tips. Sometimes guests leave the practitioner's tip at the front desk and, unfortunately, the therapist doesn't always receive that money. One spa's solution to this problem was to install a camera at the front desk. Other spas work on a cashless basis and have voucher cards that list the services/charges and guests can write in an additional tip for a specific therapist.
In most spas therapists have little autonomy when it comes to choosing to work on a specific client or deciding the type of work to be done. The exception to this in most cases is if the client acts inappropriately (see Inappropriate Touch).
One practitioner related the following, "Luckily, we could reject clients, if necessary. That's not always the case. Although there was a lot of pressure to do whatever it took to service the client even if that meant not doing a health history interview. If there was a question of ethics and the practitioner brought it to the management, the management would say that the practitioner was the professional and should make their decision. This sounds good but it seemed like the management just wasn't willing to take responsibility for decisions. Sometimes it would have been helpful for the management to step in and take a stand."
Almost every practitioner I interviewed mentioned concerns about being required to work on clients when there were contraindications present. The situations included: clients taking certain medications that made the therapist leery of doing a massage; clients with suspicious skin conditions; clients with high blood pressure; clients wanting a type of work that the practitioner did not feel was appropriate; and clients arriving under the influence of drugs or alcohol. Several therapists shared that they were expected to work on and in conditions that they were taught to handle otherwise.
The flip side to this is that many spas have the clients fill out a cursory intake and some do not allot any time for a health history. Thus health issues are not even addressed.
Another area of concern stems from the front desk people giving therapeutic recommendations without proper knowledge, such as suggesting the steam room to clients with high blood pressure.
Scope of Practice
We are all familiar with clients asking for services that are outside of a therapist's Scope of Practice or skill set. Unfortunately, on a much too frequent basis, a receptionist will book a specific service even if it isn't clear that the practitioner on duty is proficient in that technique. These same spas tend to require the practitioners to "do what they're told." One therapist said, "I am often conflicted by wanting to do what I've been taught and believe versus keeping my job. The guests pay big money and we are expected to give them what they want!"
Also, many practitioners reported that they were expected to promote services and products to their clients regardless of whether the practitioners liked the services and products.
Luckily, not all spas are like this as is reflected in the following statement from a spa director.
My main concerns regard the behavior of the therapists. Of course, as a spa, we need to maintain standards of practice which include privacy issues, treatment issues, and scope of practice. Since the facility offers a wide variety of treatments, it is important to make sure that the person doing a treatment can fully do said treatment; there are treatments that need an aesthetician for example. We need to make sure that only an aesthetician is doing the treatment, and while a massage therapist could do such a treatment, it is not really in his or her scope of practice to do so.
I also see the issue of proper representation as important. I don't want a client to think that a treatment will do something it can not do. A facial can do what it can do and a body wrap will do what it can do. Detoxification treatments cleanse the skin but don't draw toxins out of the liver for example.
Sometimes a client asks for a service that we are unable to do, or a therapist specifically is unable to do. This is usually handled by either explaining that we cannot do such a treatment, or booking the client with a therapist who is able to do so. Other than not performing a wanted treatment, we have not had many issues with clients' complaints.
Confidentiality is a hot topic--especially with the HIPAA regulations and rampant identity theft. Confidentiality guidelines for the hands-on professions generally state that information shared between client and practitioner during a session remains private. These guidelines are usually further interpreted to mean that client names, details of treatment and information shared by clients during sessions are not discussed by the practitioner with anyone else.
Confidentiality is often difficult to maintain in a spa setting. This can be due to the physical environment (literally a lack of private space) as well as blatant disregard. According to one therapist who formerly worked in a day spa where the majority of clients were locals, "Confidentiality was almost unheard of. Gossiping between employees was terrible. Everybody knew every client's business. There was no way to keep client files safe. Space and time was limited, so health histories and intake interviews often took place in front of other clients."
Many spas cater to celebrities and well-known executives. When hiring therapists at these spas, the directors look for practitioners with a mature attitude-those who are not easily awestruck. At one spa whenever a VIP makes a reservation, the managing staff is notified at the weekly management meeting. The day before the VIP arrives, the managing staff is reminded. Each day, any therapists (and other staff) who will be directly working with the VIP are reminded about confidentiality and proper interactions.
Marketing is another area that is a source of conflict. In most spas you do not have to do marketing or schedule clients, but there is no guarantee that your work hours are filled. Many practitioners discover to their dismay that to increase their client flow they need to actively market their services.
This can become an ethical dilemma particularly if the therapist has a private practice. One of the concerns is developing a system that rewards practitioners for brining in new clients. Also, there's the issue of therapists recruiting clients for their private practices. One of the practitioners interviewed eloquently addressed it with the following, "I usually don't promote myself as a therapist while working in a spa. An example of this would be giving a spa client my personal business card rather than the card of the spa. Unless the spa is accepting of this, and it's known that the therapists are allowed to do so, this in my view is an unethical thing to be doing. I feel that when I work in a spa, the client is the spa's client and not my personal client. I usually am open to doing what is best for the spa. This keeps the spa going, and in the long run affects my ability to work."
Some types of boundaries are very simple and clear cut. Unfortunately, boundaries are often blurred in a spa environment, particularly given that people often play a variety of roles. To make things even more confusing, the boundaries between any two people fluctuate. Behavior that's deemed appropriate at one time may be highly offensive in another context with the same person. Consider the following example:
The facility I've worked at for the better part of the last three years is a small hotel. As the spa manager and the only aesthetician on staff I usually end up working with most of the clients at least once. It can be difficult to maintain professional levels when you were out the previous night drinking at the local pub with a person who is your client today.
I would like to think that as such, I let the client know that the person they met last night, and the person who is giving them a treatment while the same person of course, are different. Once I put on my spa uniform and enter the spa room, that's what we are here to do.
Some spas have strict rules about boundaries and dual relationships. In one instance, a female therapist was reprimanded for meeting a client for a drink after work.
Understanding boundaries is crucial to creating an ethical practice and building professional relationships. By increasing awareness of our clients' boundaries (as well as our own), we can improve the therapeutic relationship and avoid many inadvertent slips into unethical behavior.
Inappropriate Touch & Sexual Misconduct
The most common ethical complaint from clients is sexual misconduct. We've all heard horror stories of gross misconduct, yet subtle behaviors can be just as damaging. Consider the following examples:
Several male therapists no longer work at the spa because of client complaints about inappropriate behavior. One of the male therapist was accused by a client of inappropriate draping (client stated he touched her breasts), another was accused of looking at the female client's genitalia while he was "stretching" her. Another guest complained that one of the male therapist, when seeing a tattoo on her hip of two cherries, stated he could tie a knot in the cherry stems. We have also had client complaints of inappropriate behavior that are unfounded. We recently had a client to state that one of the male therapist performed vaginal massage. This client's female companions advised management that the client had been known to tell falsehoods. No action was taken against the therapist. I think the client eventually recanted. Also, as you know the line between massage and fondling can be crossed if the therapist has that intent. I have had more than a few female clients tell me they had a "bad experience" with a male therapist in the past.
Several years ago I hired a massage therapist. I have had the fortune to hire and work with many talented therapist over the years, but this man was more than just talented....he was gifted. He was also a very handsome man with striking good looks. After he joined our Body Department he began working at one of our Day Spa locations. He was very well liked in the company and immediately began to gain a following of massage clients.
One day during his work day we had a client complaint against him. The complaint was that he was sexually inappropriate during the massage. The complaint was relayed to our corporate offices and he was terminated immediately. No questions asked. In our company we have a Zero Tolerance Policy. It applies to both therapist and clients. The policy is there to protect our therapist against inappropriate behavior from clients as well as protecting our clients against inappropriate behavior from therapist.
After he was terminated, questions began to arise as to whether anything at all had happened in the room. . . if the complaint the client had filed was actually the truth. We never talked with the therapist. We never got his side of the story. We will never know what happened. What I do know is that the company lost a gifted therapist.
Several years later someone in our company ran into his girlfriend. She told us he was devastated about what had happened. What I also know is that we were lucky that he never filed a complaint or decided to sue us for wrongful termination.
The flip side to this is when a client acts inappropriately. While many spas totally stand behind their practitioners and allow them the right to terminate a session, there are many instances where the spa culture disempowers practitioners. One therapist related how several times her younger colleagues came to her in tears because when they approached management about a client's sexual advances, the response was, "What did you do to provoke it?" Instead of refusing service to these clients the spa simply passed on "warnings" to the next therapist to be careful.
Not all inappropriate behaviors are blatant sexual advances. Clients can sexualize a session just as easily as the therapist. Consider the following example.
As a male therapist I've had just as many sexual advances from my clientele as my female colleagues. After receiving a massage from me a regular female client, an executive, would chat with the women in the nail technicians' area and sexualize the therapeutic relationship. Our professional boundaries were clear and neither I nor the client ever did anything implicitly or explicitly sexual. She never outrightly said that I did anything sexual but she portrayed the experience as something special; how hot it was to have this big, handsome man working on her. Later, some of her associates booked sessions with me expecting to receive a sexually charged session. They wanted to see what all this fuss was about and were surprised (and possibly disappointed) when nothing happened. Her sensationalizing her sexual power created an uncomfortable situation with several other individuals, including my wife. Luckily, it did not put my job at risk.
Sometimes the environment itself elicits an aura of sexuality, which while in and of itself is not unethical, it can set the stage for impropriety. Several factors influence the ethical ambience of a spa. First we must acknowledge that the nature of what is done and where it's done can elicit discomfort or confusion from clients. According to one spa director, "Clients are in a relaxed environment, it's dimly lit and private and usually there is some type of nudity and touch." Unfortunately, for many people, this triggers an association with sex.
There was a sexually alluring print on the wall in the massage room. I repeatedly brought it up to the management at meetings. But they did not follow through on evaluating it for themselves. It was not that it was a nude that bothered me. It was because the content was inappropriate for a massage room. The woman was obviously waiting for her lover. She had lace half gloves on and a garter belt with hose. It made me very uncomfortable as a massage therapist who has had to work very hard at separating sex and massage in my practice to have this print in the room. Finally, after a year I was secure enough in my life to do something that I thought could jeopardize my job, or at least my good relationship with the management. I took the print off the wall one day and sent it to the main office through the supply delivery service. No response was ever made by the management and for three years my personal mirror hung on the wall.
Ensuring High Ethical Standards
The key to creating an ethical spa environment begins with mutual respect. Unfortunately, this is where I heard many conflicting stories. The spa directors feel they are doing their best, while the majority of practitioners seem distrustful. One therapist said, "I don't truly feel that management is committed to high ethical standards. This is not to say they in any way promote unethical behavior."
Another practitioner put it very succinctly, "Money always wins." While I don't necessarily believe this is indeed the truth, spa directors need to know that this is how many practitioners feel and must take action to foster goodwill.
Generate an atmosphere that encourages cooperation and ethical behavior by doing the following:
- Review policy and procedure manuals (discuss areas of concern and clarify ambiguous policies).
- Determine logistical requirements such as who prepares the room for a session
- Set explicit duties and responsibilities
- Create clear financial contracts
- Specify marketing expectations
- Educate the front desk personnel about standards, scope of practiceand common contraindications
- Clarify the expected types and levels of communication between practitioners as well as practitioner/management and practitioner/client interactions
- Provide ongoing training in personal skills (e.g., communications, avoiding sexual harassment/misconduct) in addition to classes on modalities, products and equipment
The interviewees provided great tips for how therapists working in spas can foster an ethical environment:
- Be clear with yourself and your employer that you are willing to work with the standards of the spa
- Make sure there is alignment between what you feel is ethical and what the spa feels is ethical
- Communicate in advance about what treatments you are willing to do, and with whom you are willing to work
- Have enough tools and modality experience to work around most conditions
- Maintain confidence in your skills
- Be professional and appropriate
- Be aware that in many cases you are dealing with a transient population. Don't expect to attract many regular clients (unless you work in a day spa)
- Know what your standards are for yourself, for the spa and as a professional. When anything occurs that makes you feel uncomfortable, simply ask yourself it fits inside your boundaries
- Maintain your professional standards and hold yourself accountable for your actions
- If you feel the client is infringing on your personal space and making you uncomfortable during a session, end it and notify your supervisor immediately
- Value your own body and mind with respect as well as the bodies and minds of those to whom you are providing services
- Be a team player
- Know what you can live with and without-because you will be tested
Ethical behavior involves striving to bring the highest values into one's work and aspiring to do one's best in all interactions: doing the right thing in the right manner for the right reasons and with the right attitude. The cornerstone of ethics is self-accountability: It is about who you are and what you do when no one's watching you. When you have a well-developed sense of self-accountability you are honest with yourself, and you are answerable and fully responsible for what you say and do at all times. You have the ability to look beyond the immediate moment to consider all the consequences and know if you are willing to accept them. Keep in mind that when you treat people with decency and respect, you usually receive the same in turn.
Ultimately, only you can prevent forest fires. . . .
I wrote this article to bring to light the ethical considerations of working in spas. Please e-mail me with questions, concerns, suggestions and stories. I will address them in future issues.