1. "Wanna relax? Take a number."

Americans spent more than $9.6 billion on anti-depressants in 2008, but apparently happy pills aren't enough. In search of bliss and a good rubdown, people worldwide flock to spas making more than 130 million spa visits each year. And while spa brochures dangle such promises as "finding yourself and nurturing your soul," what you're more likely to find are other people a whole bunch of them in fact all vying for the very same services you want.

“WANTED: TRAVEL TALES”

“ The Wall Street Journal is looking for ”

“ readers travel stories ”

“. They want to hear about your favorite -- and least favorite -- trips. Maybe it was when you met your spouse, or took your children away for the first time. Or when you learned something about yourself -- or the world. The WSJ will share your stories online and publish a sample of them in print in a special section to run in the spring.”

Those crowds mean that it can be almost impossible to schedule appointments for treatments the whole reason you're there to begin with. When Bernard Burt, a veteran travel writer and coauthor of the book 100 Best Spas of the World, visited Ancient Cedars Spa at Wickaninnish Inn on Vancouver Island, he found guests scrambling to get the treatments they wanted. "The spa is just too small," Burt says. "They can't keep up with demand." An Ancient Cedars spokesperson says that the facility is a bit "intimate," adding that it has added treatment rooms, which brings the total number of rooms to seven.

Jenni Lipa, president of Spa Trek Travel in New York City, does her research to avoid the crowds. "I look at the ratio of spa treatment rooms to guest rooms and the ratio of spa staff to clientele," she says. At a destination spa, one treatment room per 10 guest rooms or one staffer per guest is a good sign, according to Lipa: "If a 300-room hotel has only three spa treatment rooms, that's a problem."

2. "The brochure rate is just an opening bid."

Everyone knows that spas aren't cheap. The nation's top destinations including the Golden Door in Escondido, Calif., and Cal-a-Vie Health Spa in Vista, Calif. will run you around $7,000 a week. But hidden extra costs can jack up your tab further even at a reasonably priced facility. The biggest culprit: gratuities, which are included in the prices at some spas but not at others. Some spas add 20% to cost of services. It s automatic if you don't ask, and may already be in your bill. So don't double tip, says travel writer Burt.

Another budget-buster: Many spas will try to sell you pricey skincare products following your treatments. And while you're not required to buy, "they're very pushy sometimes about selling these products," Burt says. "You're relaxed after a massage and susceptible to suggestion. It's big money for them."

3. "We'll rub you the wrong way."

Massages come in a variety of forms these days from intense deep-tissue work to Reiki, where the masseur barely touches you. When you enter the massage room, you may have no idea what kind you're getting. The same could be said for facial treatments.

Terry Herman, a management consultant and spa industry adviser in Westmont, Ill., had a somewhat harrowing experience with a facialist at a Chicago day spa. The woman used a lancet, a needle-like tool used to prick the skin, to remove blemishes from Herman s face. She told the facialist to stop because of the pain. Herman says she later found out that aestheticians in Illinois are not allowed to use lancets in facials. You have to pierce the skin in order to extract an impurity, which is more in line with the medical profession, so it s out of scope of aestheticians to use it, says Traci Daly, the aesthetics program director at the Atlanta Institute of Aesthetics.

What's a client to do in such cases? Spa patrons have the right to complain to the state agency that regulates these establishments. State inspectors would go check out the facility; if wrongdoing is found, the facility can be fined and the aesthetician could lose his or her license, says Daly. And if that massage isn t as gentle as you like, "you have the right to ask the therapist to lighten his touch," says Susan Lord, M.D., a physician who specializes in alternative medicine.

4. "Our therapists aren't trained."

Today there are roughly 21,000 spas in the U.S. alone generating more than $12.8 billion in annual revenue a nearly 18% increase from 2008. With so many new facilities opening up, finding enough trained masseurs, facialists and personal trainers has become a challenge for new businesses. "With so much demand, it's getting harder and harder to recruit people," says Bernard Burt. He suggests asking the spa manager to show you their therapists credentials if you have doubts about quality of staff.

Many spas get away with hiring undertrained staff because the rules are lax at best. The International Spa Association (ISPA) the closest thing to a governing authority for the industry requires that employees who provide treatment at its member spas meet certain state requirements for licensing (such as completing 500 hours of training and passing a state exam). But thanks to individual state laws, that rule doesn't amount to much. Some states don't require licenses, and standards vary within states.

If you're in the market for a facial, the ultimate stamp of approval for facialists is certification from CIDESCO, an international school for aestheticians. When in doubt, look for massage therapists who have been certified in either New York or Nebraska, since these states have the highest standards for licensing. In both states, a massage therapist must complete at least 1,000 hours of classroom instruction followed by a comprehensive exam. You can also look for members of the American Massage Therapy Association (AMTA), a professional group. Members must have completed at least 500 hours of massage therapy coursework and must also stay current with continuing education, says Melissa Martinie Colburn, president of the AMTA s California chapter.

5. "Some of our treatments are just plain silly . . ."

New and innovative treatments are continually being added to spa menus, ranging from the spiritual-sounding "aura imaging," in which a special camera takes a full-color photo of your "energy field," to the culinary, like a chocolate fondue wrap and strawberry parfait scrub.

Aside from making you hungry, are these treatments helpful? Some have exfoliating ingredients, which can get rid of dead skin cells, says Dr. Carolyn Jacob, a dermatologist in Chicago. Other than relaxing you and making you smell good, from a medical standpoint, these more exotic treatments are going to have a fairly minimal value because any of those ingredients won t really be absorbed through the skin, says Hayes Gladstone, an associate professor of dermatology at Stanford University.

6. ". . . while others are potentially harmful."

People often turn to spas in search of better health, and many facilities have responded by trying to play doctor, offering such procedures as hormone replacement therapy and "chelation therapy," which claims to clean out fatty deposits in the circulatory system. Yet only 8% of spas are officially designated "medical spas," according to the ISPA.

Spas that don't ask specific questions about your medical conditions or allergies should definitely arouse suspicion. Even some of the most traditional treatments can be hazardous to your health. Twenty minutes in the sauna, steam room, or Jacuzzi, for example, can be dangerous for someone who suffers from diabetes, high blood pressure, or heart disease, says Mary Tabacchi, an associate professor at the Cornell University School of Hotel Administration.

Some types of hydrotherapy (treatments that use water) deserve special caution. Immersion in very hot or cold water can dilate or constrict the blood vessels, which impacts blood flow. Any type of treatment that affects your blood flow can be of concern to someone with heart disease or someone with very high or low blood pressure, says Dr. Sharon Horesh Bergquist, an assistant professor of medicine at Emory University.

7. "We're not even really a spa."

According to the ISPA, the number of spas in the U.S. is growing at a rate of more than 17% a year. Nearly 80% of these establishments call themselves "day spas" meaning no overnight accommodations and many inside the industry think that term is getting abused. "Everybody calls themselves a day spa," says Hannelore Leavy, executive director of the Day Spa Association (DSA), an 800-member group based in Union City, N.J. "They just put a massage table with a curtain at the back of a salon."

To be accredited by the Day Spa Association, a facility must offer a private treatment room for each client receiving a personal service. It should also provide massage, facials, body treatments and aromatherapy, and at least one other type of service, such as a wellness treatment. Leavy says the DSA visits most member spas to check on standards.

Pseudo-spas, on the other hand, can put unsuspecting visitors in pretty weird situations. "I had a friend on business in Chicago who asked the concierge at her hotel about local spas," Leavy says. "She wound up in a massage parlor. She got the massage but was more stressed out when she came out than when she went in."

8. "No one understands what we do."

Sure, glossy travel brochures often overstate the beauty of resorts and hotels. But in the spa industry, the problem of pumped-up advertising is even more pronounced. Why? Mostly because the industry is not well understood. For starters, there's the problem of ever-changing trends, plus the fact that there are few travel agents who are up to speed on the industry, making consumers even more reliant on an individual spa's marketing materials. I always ask for a current copy [of spa offerings] to be sent via email before suggesting to the client which treatment to experience, says Spa Trek's Lipa. Many travel agents haven t experienced a spa and in some cases it s better to have the spa guest relations at the resort make your reservation, she suggests.

An objective source to check out: TripAdvisor.com, which posts unbiased consumer reviews.

9. "We're underinsured . . ."

With the growth of the spa industry, consistent standards have become an afterthought. Industry associations do exist, but membership is strictly voluntary. The biggest one, ISPA, represents about 3,200 spas worldwide, but its application process isn't exactly grueling. Members must agree to abide by the association's "standards and practices," which include requirements such as clean treatment rooms and staffers trained in CPR. They also have to adhere to a code of conduct, which is a list of spa-goers rights and responsibilities, says ISPA's executive director, Lynne Walker McNees. But in the end, spa industry regulations vary from state to state, so there s no uniform set of guidelines.

As a result, many spas carry inadequate insurance, says Mary Lynne Blaesser, a certified insurance counselor at the Marine Agency, which has provided coverage for about 15,000 spas. "In most states, the only insurance spas are required to carry by law is workers' comp," Blaesser says.Without professional or general liability in effect, an injured customer would have to seek recourse or reimbursement directly from the spa owner rather than an insurance company. However, most leases require that lessees carry general liability coverage for such things as trip and fall claims.

10. ". . . so if you're not happy, good luck getting your money back."

The combination of spotty insurance and almost nonexistent refund policies means one thing for dissatisfied customers: Good luck collecting if something goes wrong. And that applies even for the most egregious mishaps. Leandros Vrionedes, a personal-injury lawyer in New York City, had a client whose day-spa facial turned into a horror show. "The esthetician oversteamed the client and applied the wax immediately after," Vrionedes says. "She wound up taking part of this person's face off several layers of skin were removed. The spa argued that it was the fault of the product and we didn't have a case. We argued that it was the procedure." After five years of legal wrangling, including trial to verdict and an appeal, the woman received an undisclosed settlement which her lawyer describes as "not enough."

Even when a spa does carry insurance, consumers may have a tough time obtaining compensation for injury.

"Some insurance companies will fight you tooth and nail," Vrionedes says. Don't assume, though, that you have no case just because of some lengthy waiver you signed when you arrived at the facility. According to Vrionedes, some of these documents will hold up in court, but others won't especially those that are all-encompassing. If the release "absolves the spa of absolutely everything in the world," he says, courts will sometimes void the agreement.