Life, Outsourcing, and Massage Therapy – Part 2

In part 1, we discussed general busy-ness in our clients’ lives and the reason people outsource. I also introduced the idea that we as massage therapists are contracted as outsourced wellness providers. So what can we do with this?

Extend Our Reach (and Role)

So what is your role? As a massage therapist, most people would give the simple answer of “giving massage to my clients”. Close, but too vague. Sure, that is how we go about it, but really we provide wellness, stress-reduction, and all of the other benefits that our clients experience out of our work. When I say that we need to extend our reach, I mean that we need to fulfill our wellness contract. If our clients have put it into our hands to be responsible for a part of their wellness, then we better see that it gets done!

First off, communicate what it is that you are doing. “I provide wellness”, “I improve athletic performance”, whatever your mission is. Make sure your clients know it, and then let your clients know what it is that you do to get them there – that you will proactively help them with their well-being.

Being a proactive partner in your client’s health implies action on your part. I see far too many therapists that sit back and wait for clients to come to them, wait for clients to rebook, or wait for clients to respond to their marketing. Although marketing might seem to be a proactive approach, really you do something and then you have to wait for the client to respond. Gaining clients proactively is a whole new discussion, but what about the clients you already have? What can you do for the clients you already have a wellness contract with?

Be An Active Partner

Let me paint a picture for you. You enroll in a class. You show up for your first day, excited about all the great things you are going to learn. The teacher sits you down, hands you a textbook and says, “I’ll be over there if you have any questions”. How would you feel about that?

Figure out what role you can play in helping their wellness goals to become a reality. One answer is to take on some of the responsibility yourself. And I mean the responsibility for making the massage session even happen. Make sure that for every client you have, you have a plan. Make sure that that plan is well communicated and understood by both you and the client. Make sure that the plan is as much the clients as it is yours. Maybe even have them sign it (not a binding contract!) to give it a little more weight. Then help them to fulfill it. That may mean telling them straight out that if you haven’t heard from them for two weeks, you’ll call to check in with how they are doing. It may mean sitting down and planning out their session schedule so you can have a number of appointments set up and in both of your calendars. It means following up with them by phone, email, text-messaging, and smoke signals. Get the client’s agreement of course from the start. We don’t want to harass them!

This approach may seem pushy to you. However, I have found that clients appreciate the concern. I’ve called clients that I haven’t seen in a while and it’s like they’re reading from a script every time – “Oh, hi! Has it really been that long? I really need a massage! I’ve just been really busy. Thank you so much for calling! Can I come in…?”. I think it’s because they outsourced this part of theiw wellness to you in the first place and they are happy to have you do it for them.

Reminder cards can work, but it is still putting the task of remembering on them. Don’t forget, they have to remember, it has to be at a convenient time, and it has to be urgent for them to pick up the phone. Make it as easy as possible by remembering and picking up the phone for them! I know I’ve found services like Genbook (a free online scheduling service) to be great boosts, because it makes it so easy for them to get an appointment AND it sends reminder emails (or text messages too if you pay for the upgrade). Remember, it isn’t their job to keep you in business, so do the remembering for them!

Outsourcing Wellness = Opportunity

I haven’t seen many therapists take this approach to their practice. However, if you look at it this way, you could expand it to include business wellness programs, government health programs, and more. The important thing there is to demonstrate benefit, and that means a lot more than your clients walking out saying they “feel better”. You need some proof. Use research from the Massage Therapy Foundation, the Touch Research Institute, or the International Journal of Therapeutic Massage & Bodywork to back up your claims. You want to translate those studies into something meaningful to your clients. Stress-reduction may not mean much to them, but maybe helping with insomnia might.

The key is to remember that people outsource work to people who can do it better and more efficiently than they can. I would start taking a look at the different programs out there to promote wellness, pain reduction, sports performance, or whatever your specialty is and develop a program to compare and compete. Ask yourself, “how can I make this easier, more effective, and more time efficient for my clients?” and “What can I do to help my clients take advantage of massage work and stay on track?”

My money is on the fact that if you start being more proactive about your clients’ wellness it’s really a win-win for everybody.

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Life, Outsourcing, and Massage Therapy – Part 1

Just reading the title, you may be wondering what the heck I’m talking about. Well, you may have noticed that it’s been a while since I’ve posted to this blog. Life happened. Life is still happening. I teach, I have a family, car repairs, sports massage events, I’m in school taking classes, and I’m working on setting up a business. I just got busy.

The thing is, so do our clients. Often, as massage therapists, we wonder where our clients go. The truth is that many times it has nothing to do with the client not wanting to come back. Life just got in the way. Very few people I know have large blocks of time in their schedules to do with what they wish. MTs often fall prey to thinking that they are only competing against other massage therapists. Some who see a little bit more realize that they are also competing against other niche products like chiropractic, pain relief, and stress-reduction activities. But in the broader scheme of things, we are fighting tooth and claw with almost every other business (and even person) out there for one thing. Time.

Time and Our Service Economy

We are competing with sports events, TiVo, concerts, charity events, kids’ recitals, theme parks, you name it. Time is our clients’ most precious commodity. It seems that all too often, even when you want to get together with a friend, they have to check their schedule and pencil you in in three weeks. More and more, people are just so busy they can’t get away for anything.

What does that have to do with the service economy? Few would deny that massage therapy is a profession that rests firmly in the service sector. Whether you look at it as health care or a luxury, it is still a service. In one of my business classes recently, I learned that the rise of the service economy in the U.S. really began after World War II. What ended up happening is that incomes rose so that people had more to spend. At the same time, a counter-trend was occurring in that people had more demands on their time. The result was this, people began to pay others to do time-consuming services that they didn’t wish to do. Things like dry cleaning, painting the house, dining out increased. People began outsourcing more of their needs to others.

Outsourcing

The way I see it is that our clients have outsourced some of their care needs to us. We provide a therapeutic service and can rattle off all kinds of therapeutic benefits for massage therapy. We’ve been contracted to provide something that our clients want or need, but either can’t or don’t want to do themselves.

Think for a minute about the things that you want or need and can’t/won’t do for yourself. A person could get in shape without a personal trainer or a gym membership, but isn’t it easier to pay the membership or have somebody else guide you? Massage is kind of the same. People could reduce their own stress, there are many forms of massage that people really could do for themselves. But that isn’t really the issue. It’s time and focus.

General Busy-ness

A month ago, I wrote about my TFL and my plan for addressing it. I was going to chart the progress and write about it here. I know this stuff. I teach this stuff. I recommend it to my clients. Did I do it? Nope. It wasn’t important enough to me at any given moment to do much. Oh, I worked on it a few times. I got some massages at my school. But did I do the entire protocol that I laid out for myself? Sorry.

The point is that our clients are the same way. It’s not that they’re lazy, or uncommitted, or that they don’t want to be healthy. It’s that they have a gazillion priorities and their health is only one of them. Proper nutrition requires a lifetime commitment while McDonald’s only requires a commitment of $5, right now. When so many people demand so many things, something has to give. Unfortunately for us, for many people that seems to be massage and taking care of themselves.

And Back to Outsourcing

The answer to busy-ness for most people is one of two things. Put it on the back burner to be ignored or forgotten OR… outsource it. Our clients are outsourcing part of the wellbeing to us. We just need to know the best way to go about it for our particular group of customers. So what can we do to fulfill our contract as outsourced wellness providers? I’ll save that for part 2… (nice teaser, eh?)

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The Wolnick Trigger Point Protocol

OK, lame name, I know. I’ll come up with something better soon.

Over the years, I’ve dealt with a lot of trigger points. I just talked about a few of my own in my last post. Now some of these trigger points are just plain nasty. They exhibit the kind of pain that simply wants to make you cry – the “exquisite tenderness” described by Travell & Simons. I’ve seen what’s out there as far as techniques for addressing trigger points and have developed a protocol for deactivating them that has worked very well. Surprisingly enough, I’ve never seen any one source that puts all of these techniques together into a single protocol. If you have, let me know, and I’ll give them credit! This is what I teach my students and use myself. Works like a charm!

Here’s a simple version of my protocol:

1. MET
2. Cross-Fiber Friction
3. Static Compression

In that order!

MET, aka Muscle Energy Technique

MET has to be one of my favorite styles. It has some great advantages, not the least of which that it can address a trigger point without the same kind of excruciating pain as the other techniques. Simply described, MET is a technique that you can use to reset the communication between the brain and the muscle. Often, at least part of the irritation is that the nervous system is maintaining a negative feedback loop that reinforces the dysfunction in the muscle. In my experience, using MET nearly always reduces the irritation of the trigger point before you start using any more painful techniques. This decreases the discomfort of the client, and some trigger points may even disappear entirely without any pain! I love the look of confusion on a client’s face when you do a simple exercise and then their pain has disappeared. They always ask “Are you pressing in the same spot?”

MET involves a thorough knowledge of kinesiology and the ability to apply very slight resistance in precise planes of movement. You establish a clear signal between the brain and the muscle and take advantage of innate reflexes to obtain specific effects. Sounds complicated, and the reasoning behind it is, but in practice it’s fairly simple to actually perform. You can learn more about MET here, a few videos here (1 and 2), and a technical paper here.

Cross-Fiber Friction (CF)

The favored technique of Clair Davies, author of the Trigger Point Workbook, this technique has seen a rise in popularity over the years. While it is still painful to the client, the pain is in short bursts rather than a sustained pressure. This allows the client to tolerate more, but also allows for more of a pumping action in restoring circulation to the area. Davies recommends that only 6-12 good, firm strokes over the trigger point constitutes a treatment – a guideline I agree with. This prevents you from overworking the point and causing the trigger point to go active on you. Ouch.

This technique is one that you can do easily on yourself as well. This is good, since it is better to work frequently and in short bursts on a trigger point than rarely but for a long time. It is something that your clients can do at home. Often, the cross-fiber friction will take care of the trigger point aggravation. If not…

Static (Ischemic) Compression (SC)

Ahh, the good old standby of Neuromuscular Therapy (video here). This technique involves holding sustained pressure directly over the trigger point. This has the effect of increasing the pain sensation and “overloading” the neurological circuit so that it shuts down, kind of like tripping the circuit breaker. The analogy that I like to use is that of a rain bucket. The water in the bucket is the amount of irritability in the trigger point. As it fills, eventually the bucket overflows (the TrP goes active) and starts sending pain elsewhere. SC is like tossing bricks in the bucket. It causes it to overflow, but after you’ve drained some water, when you pull the bricks out there is less water in the bucket.

This is certainly the most uncomfortable of the trigger point techniques – which is precisely why I save it for last. However, there are some trigger points that don’t seem to respond to anything else. The good news is that by the time you get to static compression, the other techniques should have reduced the irritability so that this one isn’t so bad.

To perform this technique, locate the precise point of the pain, sink in to the point until you get to a pain of 7 on a scale of ten (the point where if you go past you’ll need to tense up to resist it), and hold it. If the pain is increasing, release and try something else, if it is staying the same, hold for 8-15 seconds then repeat, if it is decreasing, ride it home until it levels off.

I recommend that you only combine up to 3 treatments of either CF or SC at one time to avoid overworking the point and sending the client home in pain. It is a very common mistake to overwork a point and it is very easy to do.

Happy Trigger Point Hunting!

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Getting in Touch with Your TFL

Your Tensor Fasciae Latae (pronounced Tensor Fah-sha Lotta), or TFL, is a small, upside-down teardrop-shaped muscle in your hip. While the muscle isn’t large, it certainly has a large role in how your hips function. You can see a picture here from Gray’s Anatomy and some interactive anatomy here. The TFL helps to abduct, flex, and medially rotate your hip as well as extend your knee (or prevent it from collapsing while walking). Of course it helps to regulate the opposite of those actions too. In short, TFL is involved in every motion of the hip and the major actions of the knee! The insertion for this important little muscle is on the Iliotibial Band (ITB), that taut strip of connective tissue going down the outside of your thigh. TFL can be responsible for some considerable tenderness and tightness on the outside of the thigh.

My Connection

I think it’s funny that I teach this stuff, and I pass it along to my client’s all the time about what is good for them, and yet I have problems with my own TFLs. I had reconstructive surgery on my ACL 12 years ago and I have to say that my hips and legs haven’t been the same since. Over time, I have slowly realized that it’s not so much the surgery as how my body responded to the surgery – and the protective mechanisms I developed. Don’t ask me why it took me so long to realize this; I guess it’s easier to look objectively at somebody else’s body.

How it manifests for me is a massive trigger point in my left TFL. It’s bothered me on and off over the years – some little stress sets it off and it will make my entire leg ache. Over the past few years however, I’ve found a new pattern of periodically tweaking my hip when I carry something awkward (like a massage table) on one shoulder. Invariably it causes my left piriformis to go into spasm so that I can hardly walk – limping for several days. Only just recently have I realized a direct connection between the two pains. I have the same problems mirrored on my right side, just not as severely.

Lifting something awkwardly for a Memorial Day picnic, my piriformis went into spasm again. In working on the area myself, I probed around the rest of my hip to try to see what else was contributing. When I pressed on the latent trigger point in my TFL, my piriformis began pulsating for as long as I help the pressure. When I dug in a little further, I felt a sharp pain in the middle of my anterior shin (Tibialis Anterior) – another common site of pain for me. AHA! Paradigm shift!

Bodywork

IN my next post, I’ll go into a little more detail over the treatment protocols I intend to use to get rid of these things. I’m a massage teacher, and I can receive bodywork on a fairly regular basis. Still, I’ve been receiving bodywork regularly for years and it hasn’t done much for these trigger points. Nothing short of direct, focused efforts will do it. So here’s my plan.

First, I will make sure that I get at least one massage per week with at least some special emphasis specifically on my hips and these trigger points. Good, but that won’t be enough. Clair Davies recommends that you work on them with 6-12 good strokes multiple times per day and that you’ll see improvement in less than 2 weeks, even for the really bad ones. Well it’s proving time! I’m going to work them at least three times per day for at least two weeks and gauge the results.

I’ll keep you posted!

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Your Perception Is Your Reality

“Your perception is your reality”

I recently heard someone say this and I thought it would make a great critical thinking question, especially when applied in context to massage and our client relationships. This is a pretty deep statement and has implications that affect all aspects of our lives. Many times people perceive what they want to perceive. In class, we identified five areas of impact – personally, professionally, communication, your clients, and your work.

Personal Perceptions

Your personal perceptions dramatically affect your own self-esteem and relationships. In essence, your own self-perception is actually the basis of self-esteem. Relationships also have a large element of perception. I know that I have seen people that when they state “I’m not happy in my relationship” it is less of an observation and more of a decision. They have decided that they are not happy and that nothing about it ever will. Others seem to be able to make it through hard times by having the faith that it is only a temporary struggle and that brighter times are ahead. We call these kinds of perceptions a person’s character and we describe it in terms of being optimistic or pessimistic or cheerful or sarcastic. These personal perceptions can really color a person’s world. Stereotypes are an example of this too.

Professional Perceptions

Let’s talk about ethics first. When it comes to ethics, there are times when perceptions can matter almost more than the substance. Were you to socialize with a client, another client or professional could easily perceive the relationship as being improper. Really any interaction is open to interpretation about motives and you only have any kind of control over the impression that you present (I call it impression management). While you can’t control the thoughts of another person, you want to avoid anything that could give the “appearance of impropriety”.

Professional perceptions are also exemplified in job interviews. Your performance in that interview is dependent on how that interviewer perceives you. In this case the perception can quite literally create the reality in that you will never really be that employee unless they perceive you to be.

Communication

Since communication takes two, and the two can never completely know each other’s mind, there is an aspect of interpretation. How many times have we discovered a miscommunication because one person perceived a meaning the other never intended? Sometimes perceptions can also relate to selectivity – only seeing or hearing what one wants to see or hear. Different perspectives will also place different priorities on different things. You may intend emphasis on one thing, but someone else prioritizes another.

Your Clients

I know I’ve seen many clients who say that they are stressed. Sometimes I have to wonder how much of that is a symptom and how much is a self-fulfilling prophecy. Are they stressed, or does believing that they are stressed just allow them to accept it and not find a way to get rid of it? If a client resigns themself to a life of chronic pain, does the perception create or contribute to that reality? There is a connection.

Another aspect is the “I can’t” mentality. You know what I’m talking about. A child is working on their math homework and is saying “I can’t do it” and then after a lot of frustration and agony they do in 30 seconds what they’ve been “unable” to do for half an hour. They’re just trapped in a mindset and convinced their self that it is too hard. They can’t do it as long as they believe that they can’t. Other examples can be clients stating that they can’t function without a steady stream of caffeine, that they don’t have time to take care of their self, or eating right is impossible.

In Your Work

Perceptions here can create some conflict when you perceive something to be beneficial to a client and others may disagree. A huge example of this is I have heard of some spas prohibiting their MTs from working on clients’ gluteal areas because of the perception that it is sexual. These clients miss out on an important integrative region of their body because of a perception (I’d say misconception, but that is my perception! :D). You may perceive that a client needs more pressure to achieve the results they seek, but they perceive that the pressure is already too hard. You perceive that trigger points are to blame for the agonizing pain they are in, but they perceive that trigger point work is simply increasing the pain they are experiencing.

So What To Do About Perceptions?

The good news is that you do have control over your perceptions and, to a lesser degree, others’ perceptions as well. Even a phrase like “look on the bright side” indicates that there is a choice about how you choose to perceive something. An important thing is to do some periodic self-evaluation and see (pun intended) if there are any perceptions that hold you back. Do you have any self-fulfilling prophecies? “I think, therefore I am” could be changed to “I think ______, therefore I am _______.” To a degree, when you think certain thoughts, you start behaving in a way to start to bring those thoughts into reality. Affirmations work this way. You choose something you want to be (a perception), and through repetition you change your thought processes to make it a reality.

Another simple strategy is to just do it. How many times have you thought something was hard or impossible only to realize it wasn’t all that bad? When an event occurs that dramatically changes our entire world view, we call it a paradigm shift. We can cause these to happen intentionally by opening ourselves up to new experience.

I certainly hope that you’ve perceived this to be helpful!

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Diversity in Your Practice

Jack of all trades, master of none - or so they say.

While there is a lot of merit in specialization and becoming a master of your chosen niche, it is important not to become overly limited and specialized as well. And in that respect, I'll use another old cliche - moderation is key.

Why Diversify?

In investments, you diversify to minimize risk. In the workplace to capitalize on different cultures and viewpoints. In massage, it's both.

Risks?

What risks, you might ask? In massage school, we all should have learned (and hopefully learned well) the risks associated with improper body mechanics and repetitive strain injuries. We learn how to help our clients deal with and prevent these things in their lives. But what about ours? Massage is physical work, and even using the best body mechanics isn't going to eliminate all potential problems. We all come into this work with a different history, a different accumulation of life's wear and tear on our bodies, and different genetic predispositions. Some can certainly last longer than others, and proper body mechanics employed consistently and habitually should allow any therapist to (as I always say in class) "let you work for as long as you choose to, not for as long as your body will let you." So, performing the same movements over and over again in your work can create the potential for RSIs.

Let's not forget that we are holistic beings here, so we can't neglect emotional, mental, and spiritual aspects of specialization as well. Personally, I thrive on novelty. I love new projects, getting things kicked off, establishing procedures and efficiencies, building businesses, and starting careers (that's why I love teaching). Doing the same darn thing day in and day out is torture for me. For me, psychological burnout is a bigger concern than physical problems. There is a real danger to the client-centeredness of your practice when things become so habitual you stop asking questions and start running on autopilot. Work becomes less fulfilling, monotonous, and a chore. I'd venture to suggest that just as many, if not more, MTs leave the profession because of this as for physical reasons. It can also lead down the slippery slope of focusing on what you're getting out of it (aka $). Not a good road to go down.

Specialization has its rewards too, but I don't hear too often any discussion about the downside. A healthy MT/practice/career strikes a balance.

Diversify

OK, so over-concentration in a single area can be risky. What do I do about it? How do I diversify?

Well for starters, it may mean using some different techniques. I'm sure there are a lot of things you learned in massage school that you haven't used in a while. Or you could watch a massage DVD, even search on YouTube so you could see some different techniques. Trade massage with an MT that uses a different style than you do or purchase one. Read a book. Even learn something from a discipline that is similar but different like PT, emotional healing, yoga, breath-work... You could also just make the effort to change up the emphasis in your sessions - do a lot more stretching, try some techniques that require client participation, mix zen shiatsu into your Swedish.

Another way is to provide some complementary services. Body wraps, exfoliations, hot stone, aromatherapy, and others are all great ways to mix things up. They can use your body in a different way or potentially use your body in the same way but with an entirely different thought process. It helps to keep you (and your client) engaged in the process.

It might also mean diversifying your work environment. Getting out of a rut means breaking routine. Try working in different environments - a spa, chiropractice office, a pain clinic, a law firm, a house call, outdoors at the charity 10K... Try working with some different clients that have different challenges for you to work with.

Got some ideas on how to diversify? Let me know!

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Raising Your Rates

A touchy subject for all massage therapists. When do you do it? How? What do you say? This question was recently posted on LinkedIn's Massage Therapists & Bodyworkers group:

I would like to hear what other therapists tell their clients when they ask why you've raised prices. (or if they complain about it). I raised my prices last year from $70 to $80/hour. I was underpriced for my area, now I'm competitive. I own the business so about 30% of my clients tip but I don't count on it and it isn't expected or considered in my financing. We all know why we have to raise our prices: 1) To stay competitive and not under-value our work. 2) To pay for the increases in the cost of doing business so that our profit margin remains the same. People who are employed get annual 'cost of living' raises. we don't unless we raise our prices. I am resentful of people who don't understand this, and have a hard time coming up with a concise, professional way to explain. I certainly think I'm worth the raise, so that is not the issue, and I'm not defending that. Thanks!

Cass Vertefeuille Garrett of Greenleaf Therapies, LLC

First off, Cass has it right. When we're self-employed, we are the ones who have to give ourselves a cost-of-living adjustment. I think that Cass has already presented some good reasons why we need to raise prices, but let's take a look at the thought process behind it and the when and how of increasing rates.

Why Raise Rates?

The thought process here is a simple one. Our prices aren't static, as our clients often seem to think they are, and like we MTs can even fall into the trap of believing. There are lots of factors that drive our pricing, some of the most obvious being: inflation, increased cost-of-living, increased costs of doing business, having increased experience, training, or specialized skills, and so forth.

Because these expenses aren't static, neither can our prices. We need to build that mentality into our business plans and practices. Ideally, we should also build this into our clients' expectations. Think about the example of a client who wasn't informed that they might be sore following a massage who then becomes sore afterwards. The are upset because it was a surprise and worried that something might be wrong. The same can happen with your business practices. Build in the expectation that prices will change periodically to reflect the current economic environment and it won't be such a nasty surprise when it happens. I'd include this expectation in your policies from the very first appointment with your client.

When to Raise Rates?

The knee-jerk response to this question is "when you need to" and that is a valid answer. But it is also an answer that implies a lack of planning or control. While you do need to be responsive to factors such as rent increases and the like, that shouldn't necessarily be the only reason to look at your rates.

My recommendation is to develop a process to systematically examine your pricing structure. Earlier, I used the word "periodically" to describe when rates would change (nice foreshadowing, eh?). That means that there is some kind of established and regular time-frame for when the rate changes occur. I go with a yearly period, but you could go shorter or longer if you'd like.

This evaluation should take into account all of the changes to your personal business climate over the course of that period. Some examples:

1. Taxes - increase or decrease?
2. Expenses - personal and business
3. Inflation - don't overlook this one!
4. Local changes in the market - competition, new regulations...

Inflation alone means a pay-cut every year if you don't adjust your rates. A 3% inflation rate means you essentially earn that much less in spending power that year. Over a couple of years of static pricing, that really adds up!

Generally, I would suggest that you factor all of the cost increases in and figure out the percentage that impacts your real income (not dollar amount, but buying power). If it's not too big, you can hold off tacking on another $5 onto your rates, but then plan on it for the following year. Just make sure that you establish a schedule - a fiscal year, if you will.

How?

This is probably the one most MTs have the problem with. How do I actually break it to my clients? Won't they be resentful? Will I lose clients? These are common fears.

As far as resentment from your clients, nobody likes to have prices go up, but it's a fact of life and if you have prepared they way with client expectations it won't be as big of a deal. And losing clients? Maybe. But if a client leaves because of a small and realistic price increase, they weren't there for you, the health of your business, or the results you deliver; they were there for price alone and you won't miss them. That's a reason why I only use low introductory rates with caution - it fosters an relationship where the most important factor is your low price relative to the competition. If you do have some clients that truly cannot afford your new rates but you want to keep in your practice and they need the work - try including these clients in part of your planned charitable giving. All individuals and businesses should plan on giving some of it all away, either for free or at cost. It's good for everybody. Set aside a certain number of appointments a week (I shoot for 10%) that you can either give away or perform at a reduced price. That way the cost to you is limited, accounted for, and planned on. Everybody wins.

Breaking the news is not the most pleasant of tasks, but like other forms of boundary enforcement, it is necessary. It should be done in the spirit of both acceptance of the fact it must be done and compassion for how it affects your clients. It should be delivered firmly and clearly, with compassion but not regret or apology. Some suggestions that I posted on the LinkedIn forum:

You might try something along the lines of:
"Dear valued client, As I'm sure that you are well aware, the current economic environment has placed additional pressures on all businesses. Unfortunately, my practice has not remained isolated from these pressures and in order to continue to operate soundly I need to increase my rates to (insert your new rate schedule). These new rates are effective on (date). Thank you for your continued support."
Or...
"Periodically, I must adjust my rates to reflect changes in inflation, cost of living, and operational expenses. As a result, I will be increasing my rates to... on (date)."

Promote It

As a teacher, I've had to deal with from time to time is change - curriculum changes, textbook changes, procedural changes - and times of change can be stressful to students (and clients). The important thing when you are implementing a change, even a rate change, is to promote the positives. Sometimes it icludes an explanation about why, sometimes you just emphasize the improvements. With rates, it could be as simple as "to continue to provide the same level of service in the face of rising costs". Your students, and you clients, will pick up on your attitude about it and it does influence how they feel about it. If you are positive, it will move their feelings about it in a more positive direction. If you are negative, they will fight you on it. And if you are wishy washy about it, they will feel they can get you to make exceptions and special allowances.

One thing that can turn the change more positive is to tie in the rate increase with a promotional period. Give a date for when the new pricing takes effect and allow your clients to take advantage of getting in some more appointments at your current rate. Even allow them to buy packages or gift certificates at your current rates up until a certain date. This can have the effect of increasing both the amount of business and having money in your pocket up front. If you worry that things might get tight, you could restrict the discounted certificates to certain times or days so it doesn't interfere with your full-priced business.

So to summarize, make sure you regularly evaluate your pricing and make sure that your pricing is optimal for your business climate and meeting your needs. Be positive, firm, clear, and compassionate about how you communicate a rate increase to your clients. Expect you may lose a few, but most will understand and the ones that leave aren't the healthiest clients for your practice anyway.

Good luck!

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