Few issues can incite as much dispute on massage therapy Internet forums as a discussion about tipping. The ABMP-owned-but-open-to-all website www.massageprofessionals.com is a regular meeting place for thousands of massage therapists, and at any given time there are a half dozen different threads going on about gratuities. There are almost as many differences of opinion as there are therapists.

More often than not, the decision of whether or not to accept tips hinges on several things: how therapists view themselves in the paradigms of health-care provider versus service provider, whether one is self-employed or working for a company that may have a stated tipping policy, and the therapist’s own financial needs and wants.

If a Tip is Expected, Is It Still a Tip?

Even the very term tip is open to interpretation. The Merriam-Webster Unabridged Dictionary defines it as “a gift or a usually small sum of money tendered in payment or often in excess of prescribed or suitable payment for a service performed or anticipated.”¹ In some situations, such as certain restaurants, the tip is automatically added on to the bill no matter how the service is. 

(I once pitched a fit in an expensive restaurant, where the 20 percent tip was added on, because my family all sat there with empty glasses that were never refilled, never received our dinner rolls in spite of the waitress saying she would be right back with them, and never saw the waitress again after she deposited our food at the table. I objected to paying 20 percent of a pricey bill for the terrible service we received, and the management removed the tip.)

Adding a gratuity to the bill is standard practice in many spas, salons, and resorts, and on cruise ships.

I was a little taken aback a few days ago when I was on a discussion board; a therapist wanted to know how to word a sign to let her clients know that a tip is “expected.” The majority of therapists participating in the discussion suggested that she just raise her fees instead of expecting a tip from every client.

Medical or Not?

Judging from the comments I’ve observed on these forums, many of the therapists who view themselves as medical professionals don’t accept gratuities. Their logic is that you don’t tip a doctor or a chiropractor, so why would you tip someone else who is in a licensed health-care position? Even that attitude, though, seems closely related to the work situation of the therapist. One who works in a chiropractic office may not receive tips, while a therapist doing the same “medical” work in a private office may feel fine about accepting them.

Another therapist commented that even if you’re doing massage in a medical setting, comparing a doctor receiving a tip to a therapist receiving one was like comparing apples and oranges. She pointed out that a doctor attends school for eight years, sees more clients per day, has a lot of support staff, and charges a lot more money than a massage therapist for his or her services, all of which is true.

One medical massage therapist stated, “I view it as insulting to the client to refuse a tip. I just smile graciously and accept it. In this economy, who isn’t grateful for a little extra money?” Another said, “Clients are grateful for the work I do, and a tip is just an expression of that.”

Advice on tipping protocol from the Spring 2002 issue of Body Sense magazine is still applicable. “It’s very much an individual decision,” says Cherie Sohnen-Moe, an author, educator, and consultant for the massage profession. “[Clients] should always be getting a good massage for the fee. A tip is a thank-you. But it shouldn’t be a required part of service.” Sohnen-Moe says if the therapist does something exceptional or gives a client extra time, then tipping can be a nice gesture, but she doesn’t want clients feeling pressured or obligated to tip every time.

 “Personally,” Sohnen-Moe says, “I want my clients relaxing and getting services, not thinking anything about money.”

If there is any sort of protocol around tipping therapists, Sohnen-Moe says it’s found in spas and salons. These therapists usually have no control over what clients are being charged and also don’t reap full payment. “Typically therapists are underpaid in a lot of the salons and spas, and those tips make their day,” she says. Health spas, however, usually employ a no-tipping policy.

Ethical Considerations

Is it ever unethical to accept a tip? The Code of Ethics (borrowed from the National Certification Board for Therapeutic Massage and Bodywork) says to “Refuse any gifts or benefits that are intended to influence a referral, decision, or treatment, and that are purely for personal gain and not for the good of the client.”

Let’s examine that a little closer. Let’s say you have a client who is quite well off and always gives you a $40 tip. The massage is $60 an hour, and every week she just gives you a $100 bill and tells you to keep the change. Do you treat that client any differently from the factory worker who is genuinely scraping up the money, perhaps at the expense of something else, to pay for massage? Do you give the big tipper extra time, or ignore the fact that she’s chronically late and make another client wait while you accommodate her?

What if you work for a chiropractor who has a no-tipping policy, and a client insists on tipping you. Let’s say she offers you a tip, and you respond with, “Thank you so much, but Dr. Wells doesn’t allow gratuities,” to which she responds, “Don’t be ridiculous, here’s $20. You just put that in your pocket and he never has to know.” Are you going to argue, or accept the money? Is it unethical to accept a tip only because the employer says you can’t?

There’s a gray area surrounding what is acceptable and what is not. If a client tipped $100, would that make you uncomfortable? That may depend on the situation. A fellow therapist has cultivated an outcall business at some of the big performance venues in North Carolina and South Carolina. He works on the rich and famous musicians who come to those, and for him, a $50 or $100 tip is a common occurrence. If that same tip came from a used car salesman, you may be a little suspicious. But then again, why should you? Is the expectation of a big tip tied to someone’s celebrity? It’s judgmental to take a $100 tip from a famous wealthy person, but still be wary about taking one from the unknown person down the street.

Sometimes clients may offer you material gifts instead of money. Is there a difference? During the holidays, we’ve all gotten those gifts of homemade jelly or cookies from clients. But if someone offered you a free trip to Paris, would you be expecting any strings to be attached to that?

Another quandary: is it unethical to give tips? Is a referral fee just a fancier name for a tip? For example, if you’re doing outcalls at a fancy hotel and you compensate the concierge for recommending you to clients, it seems like splitting hairs to try to differentiate whether it’s a tip or a referral fee. If a doctor refers someone to you, the law—not to mention the Code of Ethics—prohibits any such reward for a referral. In some states, it is also illegal to offer any clients incentives or rewards for referrals. Be sure to know the laws that govern you—every state massage therapy board has a website to help keep you informed.

The Tip Conversation

If you have decided for yourself that you object to tipping, a simple sign stating, “Gratuities are not accepted” in your lobby should do the trick. Some people will ignore it and try to tip you anyway, and when that happens, a polite, “Thank you very much; I appreciate the gesture, but I’m charging what I’m worth and I’m really uncomfortable about accepting more,” is a good reply. So is, “Thank you so much, but instead of a tip, I’d really appreciate it if you would just take some of my business cards and recommend me to your friends. That would be the best tip I could get.”

If you’ve decided for yourself that you will graciously accept tips, your signage could read, “Tips are never expected, but always appreciated.”

Just like the service I get in a restaurant dictating what kind of tip I’m going to leave, the same could apply to my massage. Maybe the massage was good, but the office looked messy and the bathroom was dirty. Maybe it was a therapist I’ve never visited, and I wasn’t impressed with the massage at all. Maybe the therapist spent 10 minutes “clearing my negative energy” before getting down to the massage, even though I neither wanted nor requested that service. Maybe I’m on the road traveling and the fee for the massage is already substantially higher than what I’m used to paying at home.

If you’ve given the best massage you can give, provided a clean environment for it to happen in, and been as courteous and professional as possible, chances are good you’re going to be offered a tip. And if you’re not, that shouldn’t affect the service you give that person in the event he or she returns—that person should receive the same great massage and the same professional courtesy as the person who leaves one.

 Laura Allen is the author of A Massage Therapist’s Guide to Business (Lippincott Williams & Wilkins, 2011), Plain & Simple Guide to Therapeutic Massage and Bodywork Examinations (Lippincott Williams & Wilkins, 2009), and One Year to a Successful Massage Therapy Practice (Lippincott Williams & Wilkins, 2008). Allen is the owner of THERA-SSAGE, a continuing education facility and alternative wellness clinic of more than a dozen practitioners of different disciplines in Rutherfordton, North Carolina. Visit her website at www.thera-ssage.com.

Note
1. “Tip,” Webster’s Third New International Dictionary, Unabridged, Merriam-
Webster, 2002, accessed July 2011,
http://unabridged.merriam-webster.com.