Alzheimer's and Dementia Caregiver Certification Course

 Today, I enrolled in a four hour course in Alzheimer's and Dementia Caregiving through the Barclay Training Institute. I decided to take the course for several reasons. I wanted to add relevant continuing education to my professional background, strengthen my caregiving knowledge, and have formal education that I could reference when discussing my experience and qualifications.

After years of caring for my mother, I have personally experienced the progression of dementia from its earlier stages through advanced disease. I have learned through experience how dramatically dementia can affect memory, communication, behavior, mobility, judgment, personal care, and everyday functioning. I have experienced nearly every stage of my mother's illness, with the exception of hospice and end of life care.

Although much of the course material was familiar to me because of my years of caregiving experience, completing formal education in the subject was still valuable. It gave me an opportunity to compare what I have learned through experience with established caregiving principles and professional guidance.

And what a way to spend New Year's Eve.

I am genuinely grateful that I invested the time and money to complete the course. The course included a 20 question examination, and I missed only one question. Interestingly, the question I missed was related to a legal issue rather than caregiving itself. Legal matters are not my area of expertise, so I was not particularly surprised by that result.

The remainder of the assessment focused on caregiving, and I was pleased to see how closely my years of hands on experience aligned with the material presented in the course.

Experience Matters, but Education Matters Too

There is something reassuring about seeing the knowledge you have gained through years of experience confirmed by formal education.

Caregiving is not simply about helping someone eat, bathe, dress, or get from one room to another. It requires observation, patience, communication, safety awareness, understanding behavioral changes, recognizing when something is outside your area of expertise, and knowing when professional medical or legal assistance is necessary.

I have spent years learning these things firsthand.

Completing this course does not make me an expert in every aspect of dementia care, nor does a certificate replace the guidance of physicians, nurses, social workers, attorneys, or other qualified professionals. What it does provide is another piece of formal education that complements the experience I have already gained.

Going into the New Year, I feel more confident in my abilities as a caregiver. I have made mistakes along the way, because caregiving is a learning process, but I also know that I have taken the responsibility seriously, educated myself, sought appropriate guidance, and continually tried to do what is best for my mother.

After everything I have learned and everything I have experienced, I can finally say with confidence:

I know what I am doing as a caregiver.

The Reality of Deep Tissue Massage: When Pain Is Misinterpreted

In my 28 years as a massage therapist, I have learned that clients respond to deep tissue work in many different ways. Some remain completely silent, while others vocalize as they work through discomfort, muscle tension, and the intensity of a treatment. These reactions are not inherently unusual, nor should they automatically be interpreted as something inappropriate.

Recently, I worked with a male client who had an athletic build, excellent posture, and well-developed musculature. He requested a deep tissue massage combined with assisted stretching, both of which are areas in which I have considerable experience. Deep tissue massage is one of my specialties, and it is a service I perform frequently.

Throughout the session, the client moaned, grunted, breathed heavily, and even muttered a quiet expletive while I worked on his muscles and guided him through stretches. His vocal responses were consistent with someone reacting to the intensity of the treatment. There was nothing sexual about the session or the work being performed.

Unfortunately, sounds made during a massage can sometimes be misinterpreted by people who are not familiar with the realities of bodywork. However, vocalization is a normal human response to physical exertion and discomfort. Weightlifters grunt during demanding lifts, athletes vocalize during intense competition, and people in labor may moan or breathe heavily while managing contractions. These sounds are not inherently sexual; context matters.

Deep tissue massage involves working with the body's soft tissues, often applying sustained pressure to areas of tension. Assisted stretching can also take a client through ranges of motion they may not comfortably achieve on their own. Depending on the technique, the client's sensitivity, and the condition of the tissues, these treatments can produce intense sensations. Some clients breathe deeply, grunt, or vocalize as they respond to the pressure.

As a therapist, I monitor my clients' responses, communicate with them, and adjust my techniques as needed. My goal is to provide effective treatment while respecting the client's comfort and physical limits. After nearly three decades in this profession, I understand that each client responds differently, and I do not assume that every sound indicates a problem.

What upset me most about this particular experience was learning that a coworker had discussed my client's vocalizations with other therapists in the break room. She reportedly said she wanted to activate the emergency button so the receptionist could check on me or ask me to quiet my client.

If a staff member genuinely believes that a client or therapist may be in danger, checking on the situation through an appropriate workplace procedure is understandable. However, treating ordinary responses to an intense massage as suspicious without first establishing that something is wrong can create unnecessary concern and unfairly cast doubt on a colleague's professionalism.

There is a significant difference between responding to a legitimate safety concern and making assumptions based on sounds taken out of context. A professional workplace should encourage appropriate communication, thoughtful judgment, and respect for colleagues rather than speculation.

I was grateful that two coworkers brought the conversation to my attention. Their willingness to speak with me directly gave me an opportunity to understand what had been said and address my concerns. It also reminded me how important trust and discretion are in a shared professional environment.

After 28 years of practicing massage therapy, I take pride in my skills, work ethic, and commitment to my clients. I welcome legitimate concerns about safety and professional conduct, but I also believe that experienced therapists deserve the courtesy of having their work understood in context before conclusions are drawn.

Massage therapy is skilled, hands-on work. A client's physical response to treatment should not automatically be sexualized, and a therapist's professionalism should not be questioned based on assumptions alone.

How Do I Know if it's Dementia?

One of the most frequent questions I receive about dementia is, “How is dementia different from ordinary forgetfulness?”

I can explain this from my own experience as a caregiver. My mother has both Alzheimer’s disease and vascular dementia, and over the years I have witnessed firsthand how dramatically dementia can affect memory, communication, judgment, behavior, personality, coordination, and the ability to perform ordinary daily tasks.

It is important to understand that everyone forgets things occasionally. Forgetting why you walked into a room, having someone's name temporarily escape you, misplacing your keys, or struggling to remember a word that is “on the tip of your tongue” can happen at any age and does not, by itself, indicate dementia.

Dementia is different because the changes become more persistent and begin to interfere with a person's ability to function and understand the world around them.

Memory and Recognition

In the earlier stages, it can be difficult to distinguish dementia from normal age related forgetfulness. As dementia progresses, however, the memory problems become much more profound.

A person with dementia may walk into their own bedroom and no longer recognize it as their bedroom. They may wonder why the room is messy without realizing that the belongings belong to them. They may forget that they have lived in the same home for years or insist that they need to “go home” even when they are already there.

This is very different from simply forgetting where you left your keys.

Language and Communication

Dementia can also affect language in ways that go beyond occasionally forgetting a word.

For someone who is bilingual, language abilities can change unevenly. A person may lose the ability to express a word or thought in one language while still being able to express it in another. As dementia advances, they may have difficulty finding even familiar words, including the names of people they have known for decades.

Someone may know that a person is familiar to them but be unable to produce that person's name. In more advanced dementia, even simple conversations can become difficult to follow.

For example, I might tell my mother:

“Today at work, I had a pregnant client, and she is due in three weeks.”

My mother might hear the word “pregnant” and respond, “You're pregnant?”

Or she might hear the word “work” and ask, “Are you going to work?”

She was not following the conversation as a whole. She was responding to an isolated word that she recognized.

This can make ordinary conversations extremely challenging for caregivers because the same information may have to be repeated several times, sometimes in much simpler language.

Losing and Misplacing Things

Everyone misplaces something occasionally. Dementia can take this to another level.

A person with dementia may repeatedly lose possessions because they have placed them in unusual locations or hidden them and then forgotten where they put them. They may put cash inside a shoe and then throw the shoe into the garbage. They may put leftover food under the bed, a toothbrush in a sock drawer, or mail inside an oven.

They may then become convinced that someone stole the missing item.

Sometimes the item itself may be something the caregiver has never seen before. A person may insist that someone stole a particular object, such as a vintage camera, even though no one else remembers ever seeing it.

To the person with dementia, however, the belief can feel completely real.

Repetitive Searching and Suspicion

When people with dementia become anxious or confused, they may repeatedly open and close drawers, cabinets, closets, or other storage areas. They may be looking for something but be unable to explain what they are looking for.

This confusion can sometimes develop into suspicion or accusations.

My mother, for example, became extremely preoccupied with what other people were doing. If I brought a friend into the house, she might accuse that person of being promiscuous. If my husband worked overtime, she might insist that he had taken my money and gone to a casino.

Simply telling her that she was mistaken did not necessarily resolve the situation. Instead, she might become increasingly distressed and try repeatedly to convince me that her version of events was true.

These behaviors are not simply stubbornness. Dementia can affect judgment, perception, reasoning, and the ability to distinguish between what is actually happening and what a person believes is happening.

Changes in Behavior and Personality

Dementia can cause noticeable changes in a person's behavior and personality.

Someone who was previously polite and reserved may begin saying things that would have been completely out of character for them. They may make inappropriate comments, insult other people, use language they would never have used before, or behave in socially inappropriate ways.

In some people, dementia can also cause disinhibition or hypersexual behavior, including inappropriate sexual comments, propositions, touching, or public nudity.

These behaviors can be shocking to family members because they may seem completely inconsistent with the person's lifelong personality.

It is important to remember that the disease can impair the parts of the brain responsible for judgment, impulse control, and social behavior.

Changes in Personal Care and the Home

Another noticeable difference can be a decline in personal grooming and household organization.

Someone who once took pride in their appearance may stop maintaining their hair or makeup. Clothing may be worn incorrectly, such as shirts or sweaters being inside out, pants being backward, mismatched socks, or shoes being placed on the wrong feet.

Personal hygiene may decline as well.

The home may also become increasingly disorganized. Mail can accumulate, trash may not be thrown away, clothing may be left in piles, food can spoil, and ordinary household clutter can become overwhelming.

What once would have been recognized as garbage or something that needed to be put away may no longer be identified that way.

Unusual Behaviors and Beliefs

Dementia can also lead to behaviors that appear completely irrational to someone who does not understand the disease.

My mother, for example, once had a large supply of baby powder from the dollar store. She would pour it over herself, into her bed, and onto the floor. She genuinely believed it helped keep the house cool.

From the outside, the behavior made no logical sense.

From her perspective, however, there was a reason for doing it.

That distinction is important when caring for someone with dementia. Arguing about whether the behavior makes sense often does not solve the problem because the person's reasoning and perception have been altered by the disease.

Changes in Eating

Eating habits can change significantly as dementia progresses.

A person may suddenly dislike foods they once loved or begin eating foods they previously disliked. They may eat only small amounts or lose interest in meals altogether.

They may also forget that they have eaten.

Someone can eat breakfast and lunch and later insist that they have not eaten anything all day. To the caregiver, this can be frustrating, but the person is not necessarily lying. They may genuinely no longer remember the meals.

Safety and Falls

Dementia can also create significant safety concerns.

People with dementia may become more prone to falls because of problems with balance, coordination, judgment, spatial awareness, or physical weakness. They may also have difficulty recognizing hazards that would previously have been obvious to them.

Other accidents can occur as well, including burning food, spilling liquids, dropping objects, leaving appliances on, knocking things over, or attempting activities that are no longer safe.

Driving can become particularly dangerous when memory, judgment, reaction time, or spatial awareness are impaired.

Difficulty Following Instructions

As dementia advances, even simple instructions can become difficult to process.

For example, you might tell someone:

1. Get a pot.
2. Put water in the pot.
3. Put the pot on the stove.
4. Turn the stove on.
5. Wait for the water to boil.

A person with dementia may not be able to retain the sequence. They may hear the word “water” and simply turn on the faucet, without understanding the rest of the instructions.

This is why caregivers often have to break tasks into very small, individual steps.

Aggression and Emotional Outbursts

Dementia can also cause dramatic changes in emotional regulation.

My mother never hit me as a form of discipline when I was growing up. Yet during caregiving, she has experienced episodes in which she bit or kicked me, threatened to throw ceramic coffee mugs, or screamed intensely.

These behaviors can be extremely upsetting for family members because they are so different from the person they remember.

Again, this does not mean the person has suddenly become a different human being. The disease can affect impulse control, emotional regulation, judgment, and the ability to respond appropriately to frustration.

Hallucinations and Psychosis

Some people with dementia can also experience hallucinations, delusions, or other forms of psychosis.

My mother has seen people and things that nobody else could see. She has insisted that someone was present when there was no one there. She has talked to the ceiling, walls, and even her pillow.

This was not part of her personality before dementia.

Experiencing these symptoms as a caregiver can be frightening, particularly when the person is completely convinced that what they are seeing or experiencing is real.

The Difference Is More Than Forgetfulness

So, what is the difference between ordinary forgetfulness and dementia?

Ordinary forgetfulness happens to all of us. Dementia progressively interferes with a person's ability to remember, communicate, reason, recognize familiar people and places, perform familiar tasks, regulate behavior, and safely navigate everyday life.

A person who occasionally forgets where they put their keys is experiencing something very different from a person who puts their keys in the refrigerator, forgets doing it, becomes convinced someone stole them, and can no longer understand why the refrigerator is not an appropriate place to store keys.

Dementia is not simply “forgetfulness.” It is a progressive condition that can affect nearly every aspect of a person's functioning.

These examples are based on my personal experience as a caregiver. Dementia does not look exactly the same in every person, and symptoms vary depending on the type and stage of dementia and the individual.

But after years of caring for my mother, I have learned that there is a profound difference between occasionally forgetting something and losing the ability to understand, remember, and safely interact with the world around you.

When Pain Strikes Before the Workday Begins

I arrived at work today and had not even seen my first client when a sharp, stabbing pain struck in the area of my kidney. The pain was intense enough to make me want to reach for the nearest wall for support.

If you have never experienced that kind of pain, consider yourself fortunate. It is difficult to describe the intensity of a sudden, sharp pain that stops you in your tracks, especially when you are expected to remain on your feet and prepare for a physically demanding workday.

I'm a Massage Therapist, Not a Hugger

I am not a hugger. Never have been, probably never will be, and after nearly 50 years of living this way, I don't see that changing anytime soon.

One of my regular clients, whom my husband Trevor jokingly refers to as my “best friend,” once received her first hot stone massage from me. She had been seeing other therapists for a while but eventually returned to me. She loved the treatment so much that she wanted to hug me afterward, and when I saw her extend her arm toward me, my brain immediately went into social problem solving mode: Um, okay. I guess I'm supposed to lift my arm, too, and embrace her? It was awkward, to say the least.

I've struggled with hugging people outside my immediate family for as long as I can remember. If I can get away without hugging someone goodbye, I absolutely will. My sister April was a natural hugger and kisser who always greeted me with hugs and kisses, but I rarely, if ever, kissed her back. I honestly don't think I've ever kissed her in my life, which probably says quite a bit about how uncomfortable I am with physical affection.

It's not that I don't care about people; physical affection just doesn't come naturally to me, especially with people I don't know well. If we're not close, I'd generally prefer to maintain a little physical distance rather than feel obligated to participate in an embrace.

Yes, I'm a massage therapist, which means I touch people for a living, and I realize that sounds contradictory. However, professional touch is different from personal touch because it has a specific purpose, clear boundaries, and a professional context. I'm there to provide a service, not to socialize, share personal details, or exchange hugs afterward.

I'm also not particularly fond of talking during massages or discussing my personal life with clients. When clients lie face up, I prefer to cover their eyes with the face cradle cover and a small towel because I don't enjoy prolonged eye contact during a session. I like maintaining a quiet, professional atmosphere without feeling that I need to make conversation or establish intimacy through eye contact.

After nearly 30 years in the massage industry, I can count on one hand how many clients I've hugged. Maybe five, total, and even those hugs felt awkward because I never quite know what to do with myself. Apparently, I can spend decades working with people through therapeutic touch, yet a spontaneous hug can still leave me wondering what I'm supposed to do with my arms.

Professional touch? No problem. Unexpected hugs? Please provide advance notice and written instructions.

Massage Therapy, Celebrity Clients, and the Importance of Spa Etiquette

Today is my Monday, which means I am heading into a full weekend of back to back massage appointments. After nearly three decades in the massage therapy profession, I have learned that every client brings different needs, preferences, and expectations into the treatment room. Some sessions flow naturally, while others remind me how important communication and mutual understanding are to a successful massage.

Recently, I worked with a client who is a celebrity and who had previously received a massage from me. She was pleased enough with the experience to recommend me to her mother. While I appreciated the referral, both appointments presented challenges that made it difficult to deliver the kind of treatment I strive to provide.

One challenge massage therapists sometimes encounter is having a client direct every movement throughout the session. Client feedback is important, particularly when it comes to pressure, discomfort, and personal boundaries. However, frequent instructions about specific techniques can interrupt the therapist's rhythm and make it more difficult to create a balanced, cohesive treatment based on the body's overall needs.

The second appointment presented a different challenge. The client's mother specifically requested deep tissue massage, but repeatedly objected whenever I moved beyond lighter Swedish techniques or applied focused pressure to an area of tension. Each time I approached a trigger point or increased pressure through my thumbs, she asked me to stop or ease up. As a result, I was unable to provide the type of deep tissue treatment she had originally requested.

This situation highlights a common misunderstanding in massage therapy: firm pressure and deep tissue massage are not necessarily the same thing. Firm pressure describes the intensity of the pressure being applied, while deep tissue massage generally involves more focused work on deeper layers of muscle and connective tissue. Deep tissue does not have to be painful, and a therapist should never force pressure beyond what a client can comfortably tolerate. However, clients should understand that requesting deep tissue while consistently declining focused pressure may mean the treatment needs to be adjusted to a different approach.

Communication before a massage is essential for establishing realistic expectations. Unfortunately, some spa environments offer very limited opportunities for conversation once the treatment begins. At my workplace, a quiet atmosphere is part of the experience we provide and a major reason guests choose our spa. After the intake process, the expectation is that guests maintain a low noise level so everyone can enjoy a peaceful environment.

This makes it especially important for clients to communicate their preferences clearly during the intake process and understand the atmosphere of the facility before entering the treatment room. Respecting the quiet environment is part of spa etiquette, just as respecting the therapist's professional role and communicating about pressure are part of a successful session.

In August, I will have been a massage therapist for 28 years. That experience has taught me to pay attention to muscle tone, areas of restriction, movement patterns, and the ways different bodies respond to touch. Every client is unique, and effective massage requires adapting techniques to the individual rather than following a rigid routine.

I welcome feedback and understand that clients must feel safe and comfortable throughout their treatments. At the same time, a successful massage is a collaborative process. When clients communicate their needs clearly, respect the environment, and allow the therapist to apply professional judgment within their comfort limits, the experience is more likely to be beneficial for everyone involved.

After nearly three decades in this profession, I have learned that technical skill is only one part of providing a good massage. Whether working with a celebrity or someone seeking a quiet escape from everyday life, clear communication, realistic expectations, mutual respect, and appropriate spa etiquette are equally important to creating a treatment that works for both the client and the therapist.

Cold and Flu

This is about colds and the flu, and after nearly 30 years as a massage therapist, I cannot count how many times clients have scheduled appointments while they were actively ill.

There is a common misconception that massage can somehow “push an illness out” of the body. It cannot. Massage does not cure a cold, eliminate the flu, or force an infection out of your system. If you are experiencing active symptoms, your body needs time to recover.

If you are coughing, sneezing, experiencing fever or chills, vomiting, dealing with significant congestion, or otherwise feeling acutely ill, please reschedule your massage. A massage therapist is not the person who needs to determine whether you are contagious. If you are unsure, consult your physician and follow their advice.

For me, this is especially important because I have family members who are more vulnerable to illness. My husband has Hyper IgE syndrome, also known as Job syndrome, an immune deficiency that can make infections more difficult for him to manage and can aggravate his asthma. My mother is also elderly and has advanced dementia. When I become sick, I am not only dealing with my own illness. I risk bringing that illness home to the people who depend on me.

Even without those personal circumstances, I would still prefer not to provide massage to someone who is actively sick.

There is also a practical consideration that is sometimes overlooked: massage is close contact. Your face is positioned directly into the face cradle, which is also used by other clients. If you are coughing, sneezing, or otherwise producing respiratory secretions, that creates an additional sanitation concern for the treatment room and equipment.

If I know that a client has been actively ill, I may need to take additional cleaning and sanitation measures before the space can be used by someone else. Depending on the circumstances, I may also need to wear a mask while working. Massage therapy is physically demanding, and working while masked can make an already strenuous job more difficult for me.

I also take hand hygiene seriously. Thorough handwashing and appropriate use of hand sanitizer are part of maintaining a clean professional environment, particularly when there has been potential exposure to illness. I want to protect myself, my next client, and my family when I leave work.

Please Do Not Feel Guilty About Rescheduling

If you are sick, please stay home and recover. Rescheduling your appointment is not an inconvenience or an insult to your therapist. It is the responsible thing to do.

Massage will still be here when you feel better.

If I become sick, I cannot work. My clients depend on me, and my family depends on me. I am sure you would not want me providing your massage while I was coughing, feverish, or otherwise ill.

So please give yourself permission to rest.

If you are sick, stay home. Get better. Then come see me when you are well.

Professional Boundaries: When a Massage Appointment Must Be Declined

One evening, I had to decline my final client of the night because she had recently used cannabis. The decision upset her girlfriend, but as a massage therapist, I have a responsibility to recognize contraindications and make professional decisions that prioritize client safety.

When I brought the client into the treatment room, I began with my usual intake question.

Me: "Are there any areas you'd like me to focus on today?"

Client: "My shoulders, probably, maybe my upper back. They've been sore."

Me: "Have you recently used cannabis?"

Client: "Yes."

Me: "I can smell it quite strongly, and I'm sorry, but I won't be able to proceed with your massage tonight. Recent cannabis use can affect how someone responds to treatment, so I need to follow our professional policies. We can discuss rescheduling instead."

To her credit, the client was understanding and agreed to reschedule. I accompanied her toward the lobby to speak with the receptionist.

As we reached the lobby, I tried to keep the interaction light and reassure her that my decision was professional rather than personal. I explained that, although I occasionally use cannabis myself, I could not provide a massage under those circumstances.

Her girlfriend immediately reacted with disbelief and challenged my explanation. Rather than escalating the situation, I left the receptionist to handle the discussion and returned to my duties.

Later, I learned that the girlfriend had complained that I was rude and had allegedly told the client that she smelled bad. That was not what I said. I explained that I could smell cannabis strongly, which was the reason I could not proceed with the appointment. Identifying an odor relevant to a treatment decision is not the same as insulting a client.

Fortunately, my manager supported my decision. A coworker also agreed that declining the appointment was appropriate, particularly given the strength of the odor when the clients arrived.

The lesson is simple: professional boundaries must remain in place, even when clients disagree with them. A massage therapist should never feel pressured to proceed with a treatment simply to avoid upsetting someone. Our responsibility is to make informed decisions, follow workplace policies, communicate respectfully, and prioritize the well-being of everyone involved.

Sometimes, professionalism means knowing when not to provide a service. That decision should never require an apology for doing the right thing.

When the Past Walks Through the Treatment Room Door

My last client of the evening seemed familiar to me. As we spoke before her massage, I noticed that she had difficulty maintaining eye contact. Something about her face triggered a memory, but I couldn't immediately place it. I kept wondering where I had seen her before, yet I chose not to mention it.

Then, somewhere between preparing the treatment room and beginning the massage, I remembered fourth grade.

In 1980s Long Beach, California, I attended Jane Addams Elementary School, where I had been a student since kindergarten. Most of the children in my neighborhood attended the same school, and I had older siblings who had gone there before me. It was a familiar place where I generally felt safe, but that changed when two girls, Christie and Ebony, came into my life.

They began calling me names and threatening me, whether we were in the cafeteria or on the playground. Their behavior made school feel considerably less safe than it had before, and I learned to avoid them whenever possible. I had my own friends, and I wanted nothing more than to get through the school day without becoming their next target.

One afternoon, my friend Lina and I decided to take a different route home. Inspired by the movie A Nightmare on Elm Street, we chose Elm Avenue instead of our usual streets. It would add a little distance to our walk, but at the time, it seemed like an innocent adventure.

Unfortunately, we encountered Ebony, another girl I didn't recognize, and Joshua, a boy I remembered from school. I immediately recognized Ebony and warned Lina that if the group started talking to us, we should ignore them. I explained that Ebony had been looking for a fight with me.

We continued walking, hoping they would leave us alone. Instead, Ebony called out to me repeatedly, demanding that I turn around. When the other girl joined in, threatening to come after us if I didn't respond, I finally turned back. I told Lina that if anyone asked, she should say she was my cousin and that we needed to get home. She agreed.

As soon as I reached the group, Ebony shoved me against a wooden fence. She was much taller than I was, and I was a small child, barely 4 feet 8 inches tall and weighing approximately 65 pounds. She positioned herself in front of me, trapping me against the fence and daring me to challenge her.

She accused me of threatening to beat up a girl named Lorena, whom I had never heard of. I tried to explain that I didn't know who Lorena was, but my explanation only seemed to make things worse. Ebony slapped me, and the others joined in, accusing me of lying and mocking me for being afraid. I remember feeling confused more than anything else because I had no idea what they were talking about, yet I was being punished for an accusation I couldn't even understand.

A teenage couple happened to walk past us, and the young man noticed what was happening and challenged Ebony, asking whether she was picking on younger children. She denied it, claiming they were only talking, but I spoke up and told him the truth. He told them to pick on someone their own size, and for a moment, I thought someone had finally intervened on my behalf.

Once the couple had walked far enough away, however, Ebony punched me in the stomach and accused me of trying to get her into trouble. I didn't hit her back or cry, and I tried not to show any reaction to the blows. Lina stood nearby as the girls and Joshua eventually walked away, laughing.

All I wanted was to get home. I was less concerned about the humiliation I had just experienced than I was about the punishment I might receive from my father if I arrived home after he did. That was the reality of being a child who was being bullied while also worrying about what awaited her at home. I had learned to endure the moment and keep moving, even when I didn't know how to make sense of what had happened.

For years, I remembered those girls with anger and thought about the cruelty, humiliation, and helplessness of being a little girl who couldn't understand why someone had decided to make her a target. Then, decades later, I found myself standing in a massage treatment room, working with a client whose appearance had brought those memories rushing back.

I couldn't prove that she was the same person from my childhood. A familiar face is not confirmation of someone's identity, and I had no intention of confronting a client over a memory that might have been mistaken. Nevertheless, the resemblance was enough to stir up feelings I hadn't expected to revisit.

As I worked, I found myself thinking about the little girl I had been. I remembered how small and vulnerable she was, how she had stood against a fence and tried to explain herself, and how she had walked home carrying an experience she didn't know how to process. But I wasn't that little girl anymore.

I had grown up, built a career, and spent nearly three decades developing my skills as a massage therapist. I had learned how to remain composed in difficult situations and how to separate my personal feelings from my professional responsibilities. Whatever I was feeling internally, my client was there for a massage, and I was responsible for providing a professional service.

So I did my job. I gave her the same focused attention and professional care I would give any other client, without bringing up my childhood, asking whether she remembered me, or allowing my suspicions to interfere with the treatment.

When the session ended, she was delighted. "Wow, that was the best massage I've ever had," she told me. "I can go home and relax now." I thanked her politely and wished her a pleasant evening, and she returned the courtesy before leaving. She went home feeling relaxed and satisfied with her massage, while I was left reflecting on an unexpected encounter with a painful part of my past.

There is something remarkable about realizing how much time has passed since you were a child who felt powerless. The memories may remain, and the emotions may resurface when you least expect them, but you are no longer limited to the choices available to you back then. I cannot change what happened on Elm Avenue or go back and protect the little girl I was, but I can recognize how far I have come.

The child who once stood against a fence, trying to defend herself against an accusation she didn't understand, grew into a woman who could stand in a treatment room, experience an unexpected flood of emotion, and still conduct herself professionally. That evening reminded me that healing doesn't always mean forgetting what happened; sometimes, it means recognizing that the past no longer has the same power over you.

I may never know whether my client was one of the girls who bullied me decades ago. What I do know is that I handled the encounter differently than the child I once was could have imagined. I was no longer powerless, and I didn't need to prove it to anyone. I simply did my job, maintained my professionalism, and let the past remain where it belonged: behind me.

Spa Etiquette: Respecting the Space, the Therapist, and the Treatment

One of my biggest professional frustrations is when clients arrive late, still need to complete their intake paperwork, and then introduce additional delays by taking photographs or recording videos for social media. Loud conversations can also be disruptive, particularly in a spa environment designed to provide clients with a quiet, relaxing experience.

The spa where I work uses hemp fabric partitions rather than solid walls, so sound travels easily between treatment rooms. It is generally so quiet that even the smallest noise stands out. Before bringing clients into the treatment area, I make a point of explaining, “This is a quiet space beyond this door, so we will need to whisper when communicating.” I want every client to enjoy a peaceful experience, and that requires consideration from everyone in the building.

Tonight, however, I encountered a client who seemed unfamiliar with basic spa etiquette. Not only did she begin recording inside the spa, but she also filmed me walking down the hallway as I escorted her to her treatment room. When I turned around, I realized her phone was pointed directly at me. I did not smile for the camera, and she eventually stopped recording before explaining, at full speaking volume, “I record for my Insta...” I immediately shushed her, and she seemed to realize her mistake, covering her mouth with an expression that suggested she understood.

The interaction continued to be challenging. While I was explaining where she could place her belongings, she interrupted me to ask whether she was supposed to remove all her clothing. I calmly started over and explained that she should undress to her comfort level, that most female clients remove their bras while keeping their underwear on, and that she could hang her clothes or place them in a basket. I also explained where to put jewelry, reminded her to silence her phone, and let her know I would begin the massage with her lying face down beneath the sheet.

When I returned to the room, I found her already lying on the massage table, holding up her hair, which was styled in a bun with box braids. She asked whether I had a hair tie. I excused myself and obtained one from the front desk, but by that point, my patience was wearing thin. I had already lost time to her late arrival, the recording, and the repeated interruptions.

Clients with braids, locs, or natural hairstyles often arrive with a bonnet, scarf, or headband to help keep their hair in place during a massage. Of course, not everyone will think of every detail in advance, and I understand that first-time spa guests may not know what to expect. However, arriving prepared and following basic instructions helps the appointment run smoothly, especially when the schedule is full.

Because she arrived late, her scheduled 80-minute massage was reduced to 60 minutes. I did not extend the appointment or allow the delays to affect the clients scheduled after her. A therapist's time is valuable, and maintaining the schedule is part of being professional.

Valentine's Day is one of the busiest times of the year at the spa. We see plenty of first-time clients, people who have never experienced a professional massage, and guests who may not be familiar with spa etiquette. I enjoy introducing new clients to massage therapy, but managing a full schedule while repeatedly explaining expectations can be exhausting. By the end of a busy shift, my patience can wear thin, and tonight was no exception.

Out of curiosity, I later searched her name online and discovered that she was a psychotherapist with an Instagram account featuring four videos and approximately 120 followers. That discovery made me reflect on the irony of the situation, although the size of someone's social media following is beside the point. Whether someone has a handful of followers or millions, a professional treatment space is not automatically a place to record other people without their permission.

Ultimately, spa etiquette comes down to consideration. Arriving on time, keeping your voice low, silencing your phone, respecting the privacy of others, and listening when your therapist explains the treatment process are simple courtesies that make a meaningful difference. A massage should be a relaxing experience for the client, but creating that experience also requires cooperation and respect for the therapist and the shared environment.

When an 80-Minute Appointment Becomes a 60-Minute Massage

One of the realities of working as a massage therapist is managing late arrivals while maintaining a professional schedule. When a client books an 80-minute session but arrives late, the appointment does not automatically extend beyond its scheduled end time, especially when another client is waiting.

Recently, I had an 80-minute client arrive late for her appointment. As much as I enjoy providing a thorough massage, I also have to respect my own energy, my schedule, and the clients booked after her. Extending a session would have meant inconveniencing someone else, and that was not an option.

Her massage ended at the scheduled time, giving her approximately 60 minutes of treatment rather than the full 80 minutes she had booked. She seemed unhappy with the outcome and asked me, “Was that 80 minutes?”

I calmly replied, “Your session was from 3:30 to 4:50. It is now 4:50.”

The appointment had ended exactly when it was scheduled to end. Unfortunately, she left without leaving a gratuity, but that was her decision.

Experiences like this reinforce an important point about appointment-based services: the scheduled end time remains the scheduled end time, even when a client arrives late. Massage therapists have responsibilities to every person on their schedule, not just the client currently on the table.

Arriving on time allows clients to receive the service they booked without creating unnecessary pressure on the therapist or delaying the next appointment. A little consideration goes a long way, and punctuality helps ensure that everyone's time is respected.

When Client Satisfaction Comes at the Expense of the Massage Therapist

Most of my clients leave their sessions satisfied with my work, but occasionally, I encounter a client whose expectations are difficult to reconcile with my professional judgment and physical limitations.

One recent experience left me questioning how much responsibility massage therapists are expected to shoulder when a client is dissatisfied, particularly when a business prioritizes customer retention over the well-being of its employees.

This particular client specifically requested me because she had received a massage from me previously, in September 2024, and had praised my work. In fact, I had given her one of my supervisor's complimentary massages after she expressed dissatisfaction with the therapist she had seen before me. Given her positive experience the first time, I had no reason to anticipate any issues with our next session.

On January 12, she requested focused work on her scalenes because she had been experiencing neck discomfort. She also wanted deep tissue pressure throughout the session. I dedicated nearly the entire massage to her upper body, working from between her shoulder blades up toward the base of her skull, including extensive work on her neck. When she was lying supine, I continued working on her neck, clavicular region, and upper pectoral muscles.

Approximately 30 minutes into the session, the middle, ring, and pinky fingers of my right hand began cramping. Even supporting her head with my right hand while using my left hand to work on her neck caused discomfort. I had to adjust my body mechanics and support her head with my arm to give my hand some relief while continuing the treatment.

Despite the physical strain, I believed I had provided focused, effective work in accordance with her requests. Her assessment, however, was very different from mine.

At the end of the session, I asked how she was feeling. She told me, "My neck is still tight. Next time I want JUST my neck worked on and my sacrum."

I was frustrated and disappointed. I had spent the overwhelming majority of the session addressing her upper body, including the very area she had identified as her primary concern. I had listened to her requests, adapted my techniques, and pushed through considerable discomfort to accommodate her preference for deep tissue work.

Her response left me feeling as though the effort and physical demands of the session had gone unrecognized.

There is an important distinction between a client communicating that an area still feels tight and a therapist failing to address the requested area. Massage therapy does not guarantee that every sensation of tension will disappear after one session. Persistent tightness does not automatically mean the treatment was ineffective, nor does it necessarily mean that applying more pressure or narrowing the focus further will produce a better outcome.

In my experience, allowing a therapist to assess and address the body as a whole can sometimes be more beneficial than restricting treatment to a single area. However, clients are entitled to express their preferences, and therapists must communicate clearly about what can reasonably be accomplished within the allotted time. The challenge arises when a client's desired outcome conflicts with the therapist's professional assessment or physical ability to deliver the requested treatment safely.

Fortunately, my lunch break was scheduled immediately after this appointment, giving me an opportunity to rest my hands. I shortened that break to speak with my supervisor because I wanted to explain what had happened and make it clear that I did not wish to work with this client again.

Although she had been pleasant and friendly throughout the appointment, I was concerned about the prospect of repeating a session that had left me physically uncomfortable and exhausted. I did not believe our expectations were aligned, and I did not want to put myself in a position where I would feel compelled to work beyond my physical limits to satisfy her.

My supervisor responded, "Yeah, she thinks you aren't a good match."

I found that response ironic, considering the client had previously praised my work and left a session with me feeling wonderful. This was also the second time she had complained about a massage therapist at our establishment. While clients are certainly entitled to express dissatisfaction, a recurring pattern of complaints raises questions about whether the issue is always the therapist or whether expectations need to be addressed more clearly.

Nevertheless, the decision was made to schedule her another complimentary massage, this time with a different therapist.

What made that decision particularly frustrating was the physical history of the therapist assigned to her. This colleague had only recently recovered from approximately 18 months away from work because of hand pain and has carpal tunnel syndrome. Knowing how physically demanding deep tissue massage can be, I worried about placing another therapist in a potentially difficult situation.

Massage therapy is physically demanding work. Our hands, wrists, fingers, shoulders, and backs are essential tools of our profession, and repeated strain can have serious consequences for our ability to work. We cannot simply replace those tools when they become injured. Our livelihoods depend on maintaining them.

This is why I believe massage businesses need to establish reasonable boundaries when handling complaints. Client satisfaction matters, and legitimate concerns should always be taken seriously. However, repeatedly offering complimentary services to dissatisfied clients without examining the circumstances can create an unhealthy precedent. It may unintentionally reward unreasonable expectations while placing additional physical and emotional pressure on therapists who are already working hard to provide quality care.

I understand that business owners worry about negative Yelp and Google reviews. Online reputations influence customer decisions, and no business wants a public complaint to discourage potential clients. However, trying to prevent every negative review by automatically offering another free service is not always the best solution.

There is a difference between addressing a legitimate service concern and attempting to appease every dissatisfied customer at any cost. Sometimes, the appropriate response is to have an honest conversation about expectations, explain the limitations of a massage session, or acknowledge that a particular therapist and client may not be a suitable match.

Massage therapists are professionals, not machines. We cannot guarantee that every client will leave completely pain-free, and we should never be expected to sacrifice our physical well-being to meet an outcome that may not be realistic.

Ultimately, a successful massage practice should protect both the client experience and the people providing the service. Clients deserve to feel heard and respected, but therapists deserve the same consideration.

A business should not have to choose between customer satisfaction and employee well-being. Both matter, and neither should come at the expense of the other.

Experience Speaks for Itself: 27 Years in Massage Therapy

I snagged another client from a fellow massage therapist, and I always feel a little guilty when that happens. She initially wanted my coworker, who is her regular massage therapist, but he wasn't available. She asked for a list of available therapists, randomly selected my name, and ended up having quite an experience.

She explained that she had pain where her neck attaches to her skull and specifically instructed me to avoid that area because it makes her dizzy. She also asked me not to stretch her neck or turn it too quickly. Absolutely, ma'am. Your comfort and safety come first. She then proceeded to explain how her regular massage therapist massages her. I smiled internally. Noted, but I'm not here to duplicate someone else's work.

I respected every one of her requests, but I also brought my own experience and skill set to the table. Although she booked a Swedish massage, I incorporated some traction, Shiatsu techniques, deep tissue work, appropriate stretching, and heat where I felt they would benefit her. I knew my coworker generally sticks to the traditional Swedish massage approach, but my style is different. I don't believe in giving every client the same routine just because that's what the menu says.

I have to admit, I struggle when clients try to direct me to replicate another therapist's massage. I respect that everyone has their own style, but I have spent 27 years developing mine. I'm not interested in being a copy of someone else when I know what I bring to the table.

There is a difference between a chef and a cook, between powerhouse music and karaoke, and between a taxi and a chauffeur. All have their place, but the experience is not the same. If you're looking for someone to simply go through the motions, I might not be your therapist. I take pride in my work, and I'm not going to apologize for that.

At one point, while I was working on her left hand, I could practically see the knots in her trapezius muscles calling my name. They were bothering me so much that I went back to address them. She was surprised and asked, "You can see them?" Yes, ma'am. Afterward, she was so impressed with her experience that she rebooked with me instead of her usual therapist.

And that, right there, is why experience matters.

I've been a massage therapist for 27 years, working in chiropractic offices, medical clinics, acupuncture clinics, high-end resort spas, boutique spas, day spas, and my own practice. I've worked with young children, older adults, amputees, and people living with chronic and terminal illnesses. I've seen a wide range of bodies, conditions, limitations, and needs throughout my career.

Massage therapy has been part of my life for as long as I can remember. I was literally born to a massage therapist, and I've been receiving massages since infancy. My understanding of this profession didn't begin when I earned my credentials. It has been shaped by a lifetime of exposure, decades of hands-on experience, and years of learning how to recognize what different bodies need.

So yes, I'm tooting my own horn, and I'm perfectly fine with that. After 27 years in this industry, I know what I'm doing. I know the difference between following a routine and delivering a personalized experience, and I know the value of trusting my hands, my training, and my professional judgment.

I'm not trying to be everyone's massage therapist. I'm committed to being the best therapist I can be for the clients who choose me.