On Not “Charging What You’re Worth” in Oncology Massage Therapy

Recently, in a group of oncology massage therapists, I started a discussion about setting fees for massage therapy.

In this particular group, we were all in private practice. They were all participants in my oncology massage therapy mentorship program, and we were talking about money and pricing.

It is a charged topic, this question of what to charge. Massage therapists in private practice are the deciders, but those decisions can be fraught with pressure and confusion.

Our conversation went in several directions and plunged through several layers. How high, how low, whether to discount, how to raise fees when it is time.

But by the time we brought the discussion to a rest, we had focused heavily on one topic:

The Tangible Value of Oncology Massage Therapy

This might not seem like a new or particularly earth-shattering topic. But it is worth revisiting with care. Here is why:

As we talked, we shifted our conversation away from the therapist and toward the therapy.  Eventually we did one better and shifted it toward the therapeutic outcomes.

By focusing on outcomes rather than our service, or ourselves, we achieve an important separation. Setting fees requires that we separate ourselves from our work. Even though who we are is a part of what we bring to the session, it is liberating to see our service as separate from ourselves.

Why?

“I Should Charge What I’m Worth**” Can Be a Trap

It’s too easy to fall into the trap of “I should charge what I am worth.” I’ve even encountered MTs who ask each client to pay what the client feels the therapist is worth. Deferring to the client for the final word can be problematic, to say the least.

But equally troubling is the notion that we charge based on what we are worth.

When we do, a simple fee for a simple service becomes gnarled up in self-worth. Add in all the emotional energetics of money and self-esteem, along with the gender wage gap and other social forces, “charging what I’m worth,” is a prescription for confusion. Pile on the intimacy of massage therapy and the therapeutic relationship, and it could take decades to disentangle it all.

Here is an important nugget that can clear things up in a hurry:

The Intrinsic Value of a Human Being is not up for Sale.

It never was. Each person is perfect and sacred, beyond the language of “value.” Not a single person’s worth is affected by their choice of pricing. Not one person’s worth can ever be captured in a $50 or $80 or $150 hourly fee.

No, you’re not for sale.

Even the value of your time is not up for debate. So what are you selling?

Your solutions are for sale.

It’s useful to remember that we work in a service industry. In service industries, we solve problems. We bring expertise and energy to problems that are hard or impossible for people to solve by themselves.

I do not know how to shingle a roof or fix blown plumbing. I cannot cut hair well enough for school picture day. When I hire the roofer, the plumber, or the hair stylist, I pay them for their service. Not because they are “worth” something, but because it is worth something to me have those problems solved. Especially the night before picture day.

The Industry of Solutions

In massage therapy, we would do well to remember our membership in the service industry. It is important to focus on the problems we are known to solve, and those we have the potential to solve.

In oncology massage therapy, that list of problems is compelling. People in cancer treatment and post-treatment deal with pain, nausea, fatigue, stress, trauma, insomnia, isolation, poor body image, stigma, anxiety, and depression.

That’s the short list.

Does Research Back up These “Solved Problems?”

Research on oncology massage therapy is still in a tender place, but there is growing research on massage therapy helping the “Big 5” symptoms in cancer care: pain, nausea, fatigue, anxiety, and depression. From that body of research, the strongest support seems to be for pain relief and easing anxiety.

More generally (across multiple populations, not just oncology), there is compelling evidence that massage therapy is as helpful as psychotherapy for the problems of anxiety and depression.*** That  alone is worth celebrating.

We can make clear and accurate claims about massage as follows: “Research suggests massage therapy can help people with cancer and cancer histories with the following: pain, anxiety, fatigue, depression, and nausea,” or, “There is strong research showing massage therapy is as effective as psychotherapy for anxiety and depression.”

Neither of these claims over-promises or overstates what we know. (For a list of claims to avoid because they do overstate and over-promise, download my free e-book, “5 Myths and Truths about Massage Therapy: Letting Go without Losing Heart.”)

Clients Tell Us We Solve Problems

Research aside, we have other reasons to promote our work to oncology clients. These reasons come from the clients themselves.

Over many years, my clients have told me tangible, intangible, and sometimes surprising benefits that they attribute to massage therapy: That massage helps them sleep. With massage therapy they feel less isolated and stigmatized. Massage helps them feel feel cared for and appreciated. They look forward to pleasurable sensations from massage, after months of needle sticks and scans. They tell me that when they receive regular massage therapy, they feel better able to cope.

These benefits are worth money.

Our clients’ observations count for a lot. They are telling us why massage matters to them, with or without rafts of research behind them.

We Solve Other People’s Problems, Too

In addition to the client with cancer, there are others in the circle of care who are helped by our services. Nurses tell us that that massage therapy eases the nursing workload. They notice that when MTs are working with inpatients, the nurses themselves do not have to respond to so many call buttons. This is worth money.

Other people’s burdens are also eased by oncology massage therapy: The out-of-state uncle or daughter who purchases a session for a family member. A group of co-workers who finds a meaningful gift in a package of sessions. An exhausted caregiver who gets an hour off while the MT sees their loved one in the home. The cancer rehab PT who works more effectively when a patient’s muscles are already relaxed.

These things are worth money.

Our clients, client communities, and health care providers tell us that massage is solving problems. With or without research, theirs is an honest truth.

Charge for Solving Problems

Oncology massage therapy has enough of a track record to be well-compensated. We can charge accordingly, without getting ourselves or our self-worth mixed up in it. Oncology massage therapy is well-received. It feels really good.

That sigh of contentment once we’ve bolstered and positioned a client–even that is worth something. (So often, after I’ve set up my client for the session, she’ll sigh and begin to relax deeply. When I suggest I just excuse myself for an hour while she rests on my warm table, she nods…”Whatever.”)

Relaxation is part of the solution. Sometimes it is the entire solution.

“Massage Therapists: The People who Practice Massage Best.”

Zoom out. Look at the field of massage therapy, not just oncology massage therapy. Even massage therapists do not always appreciate the value of basic relaxation massage therapy. Sometimes we search for more powerful techniques, forgetting how highly effective our Swedish massage foundation is.

Years ago, I attended a workshop on breathing problems with Leon Chaitow. He presented the osteopathic view and the PT view and an intricate account of the problems to address with precise manipulations. Then he said something like, “But massage. Don’t forget massage! It’s really helpful.” Gesturing to the crowd, he continued: “And you’re the only ones who can really do it. Or, at least, you are the best at it. Remember to massage!”

It was amusing to have to be reminded of this, but I loved the simplicity of his endorsement. We’re good at massage. Unadorned, un-fancy, effective massage.

When questions of worth enter in, they can confuse matters. Yet all by itself, massage therapy is a compelling service. Our skills are badly needed.

Those Skills are Worth Something

We live in a market economy, where services are exchanged for money to solve problems. Our services should be no exception. We can exchange skilled touch for money, because skilled touch solves problems.

I have more to say about pricing, and our tendencies to over- and undercharge in some cases. There are sometimes special circumstances in force, or a client’s financial need to consider in pricing. I’ll share those thoughts soon.

Meanwhile, remember this important starting point: Pricing does not have to be so personal.

Pricing Does Not Have to be Personal

It is not so much about the problem-solver, or what you, as a therapist or a person are worth. It is more about the results.

Disentangling the self from the service can be freeing. A focus on the service can reveal a much clearer perspective, one where difficult problems demand good solutions.

With that perspective, we are uniquely equipped to provide good solutions.

We can and should be well-compensated for them.

**********

*After I wrote this post, I noticed a Facebook discussion about “charging what you’re worth.” I did not have time to incorporate that discussion here, but if you follow Irene Diamond or Sandy Fritz on Facebook, they tackled this as well. I highly recommend taking a look.

** Do not get me started on the fuzziness of the term, “deep tissue.” That’s a topic for another post.

***Moyer CA. Rounds J, Hannum JW. A meta-analysis of massage therapy research. Psychol Bull. 2004 Jan;130(1):3-18. Every MT should read it.