Ask any group of massage therapists this question, as I did in a recent ethics workshop at an AMTA regional conference, and you are likely to get responses that reflect strong, but different, opinions. The answers that came forth from almost 200 participants assured me that tipping is a matter that remains undefined, controversial, and not often discussed in the massage and bodywork profession. When the issue is brought up, my experience has been that massage therapists typically form two polarized camps around the subject: one group believes it is appropriate, the other group believes it is inappropriate. Discussion and debate usually follows, and, in my experience, the groups have the opportunity to express themselves and, in the end, the two groups agree to disagree. One participant, when asked if she thought it was appropriate to accept tips, summed up the matter with this reply: “I was hoping that you would tell me the right thing to do in my practice… it’s my biggest dilemma.”
Regarding tipping etiquette, there are two classifications of professions – one that expects and accepts tips, and the other that neither expects tips nor accepts them. The main reason why the appropriateness of accepting tips remains so questionable for massage therapists is because as a profession, massage can actually fit into both categories, depending on the circumstances. Herein lies the problem.
Consider the nursing, dental hygiene, and physical therapy professions. All are clearly health care professions, and all practitioners in these professions know that they are members of the health profession. Tipping, for them, is a non-issue. These practitioners do not expect to receive tips, and the recipients of their services do not expect to tip them. Their wages are generally substantial, and they are not dependent upon tips to fortify their income.
In contrast, consider the hairdressing and beauty profession, which is not categorized as a health profession, but is typically considered part of the service industry. Hairdressers and manicurists, unlike nurses or physical therapists, do expect and accept tips, and the recipients of their services expect to tip them. Their hourly wages are generally lower, and they rely on tips as part of their income. Other professions also fit into this classification, such as the food service professions.
The matter is not so clear-cut in regards to massage therapy. Asked the question, “Do you consider yourself to be part of the health care profession or the service industry?” nearly one half of the ethics workshop participants responded that they consider themselves to be part of the service industry, while the other half responded that they consider themselves to be health professionals. There are at least two reasons for these varying perspectives. First is the fact that there are many different types and styles of massage therapy. While it cannot be disputed that massage has many health benefits, and that no matter where massage is done, the client’s health is promoted, relaxation massage in a spa is generally a much different experience than rehabilitative massage for a rotator cuff injury in a physical therapy office. Secondly, massage is practiced in many diverse settings, some medically oriented, some service oriented. Massage can be found everywhere from spas, cruise ships, salons and casinos to hospitals, medical offices and athletic fields. Another reason practitioners might categorize themselves differently is because the slant of their training may have shaped their perspective. Some educational systems focus on the energy aspect of bodywork, others on the beauty and spa aspects of massage and bodywork, and others on the scientific, medical model.
All this adds up to one conclusion: consensus and standardization regarding tips is difficult, if not impossible. While it may be typical and appropriate for a massage therapist who works in a salon to accept tips, it may be uncharacteristic and inappropriate for a massage therapist to accept tips in a medical office setting. To further complicate the matter, as evidenced in the ethics workshop, there are massage therapists who work in both settings, which means that they feel comfortable accepting tips two days a week when they work in a day spa, but they don’t accept tips the other three days a week when they work in a chiropractic office. Or, as one participant explained, confusion arises in the setting where the owner of the massage therapy practice doesn’t accept tips because she gets the full fee charged, but the four therapists who work for her in the practice do accept tips because they receive only a percentage of the fee. In this case, therapists in the same setting have different policies around accepting tips.
Clearly, each therapist’s situation is unique, and so there can be no “right” or “wrong” regarding massage therapy and tips. The best answer is “It depends.” It depends on the circumstances and the individual massage therapist’s “appropriateness barometer”.
I remember my own process of discovery around the issue of accepting tips in my practice. I began my massage career in a rented room in a nail salon where the climate supported accepting tips. Coming from the nursing profession, though, accepting a tip from a client felt improper, because, although I worked in a salon, I considered myself to be a health professional. I graciously refused tips when offered, politely encouraging my clients to save the money and put it toward their next massage. Occasionally, a client would insist, and I would accept the tip to avoid the awkwardness. Inwardly, though, I felt it was wrong. Very often, clients would bring me food, trinkets from their vacations, and other gifts of appreciation, and it confused me to observe myself feeling comfortable accepting the non-money gifts when I did not feel comfortable accepting a tip. Somehow, I could justify accepting a gesture of appreciation if it was not money, but I held the belief that accepting money was wrong. As usual, life gave me an opportunity to challenge my beliefs.
Later, when I was working out of an office in my home, a client handed.me twenty dollars more than my fee. I responded with my usual reply, “Thank you for the compliment, but I don’t accept tips. Please put that toward your next massage.” When the client explained his intention to me, it broadened my perspective. He said, “This isn’t meant to be a tip. I feel I’m paying you what you are worth to me. I have spent thousands of dollars in other medical offices trying to get rid of this pain, and nothing has helped me. You made my pain go away, and in my opinion, you deserve much more than this twenty dollars. Please take it; it means a lot to me that you know how much I appreciate you.” My client was paying me what my services were worth to him, and it felt fitting and right for me to graciously accept the extra twenty dollars.
This experience taught me that I had not considered the client’s perspective in the matter. I now realize that massage is a much different experience for people; different from getting their teeth cleaned, having their meal served to them, and having their hair styled. We touch much more than a person’s physical body in the massage experience, and the benefits they receive are sometimes profound and not always fully evident to us. Many clients want to express their gratitude and appreciation, and oftentimes, a tip is the easiest way they know. Since that incident, I have given up my rule of , “I don’t accept tips.” Now, I decide each situation as it arises. Sometimes I accept them, and other times I don’t.
Am I saying that massage therapists should accept tips? Certainly not. There are no rules when it comes to this complicated issue, although I do think it is inappropriate for a massage therapist to solicit tips in any setting. What matters is that each individual therapist has the right to determine for themselves, based on their clientele, their practice setting, their beliefs, and their own appropriateness barometer, how to respond to a client who offers them a tip.
— by Dianne Polseno, President of Cortiva Institute – Boston massage school
