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In the 1980s, when Susan Harmsworth dreamed up the concept for ESPA—now a multi-million dollar company that regularly collaborates with luxury giants like the Peninsula and Four Seasons—the concept of the spa as we know it today was non-existent. “The industry was all medical-based,” says Harmsworth, “and people went on week-long jaunts, either to address serious health issues or to lose weight.” With ESPA, Harmsworth introduced the importance of the mind-body connection, pioneering an integrative approach and innovating holistic treatments. Today, there are more than fity ESPAs around the world, including recently opened ones at Gleneagles, Scotland, and at the Ritz-Carlton in Moscow (eight more are slated to be unveiled this year). Indagare spoke to Harmsworth about her background, new spa trends and some of her favorite places to get away from it all.

What are the biggest changes you’ve seen in the industry since you began working on the ESPA brand?

The biggest change I’ve seen is the switch from going to a spa for clinical problems to dealing with stress-related issues. Starting in the mid-eighties, stress became the major factor in people’s lives and they began seeking out spas to try and find a balance. The demand for shorter spa getaways became apparent, and spas started to dominate the hotel market, as opposed to health and fitness centers.

Tell us about the first spa you oversaw.

It was all about developing holistic treatments and examining the mind-body-skin connection. The treatments we developed were much more integrative, as we were trying to address the deep levels of stress that were reflected in people’s bodies and minds and skin. What’s funny is that now we’re actually seeing a swing back, with people seeking out spas to deal with more serious issues, whether it’s nutrition or making a big lifestyle change.

Are you referring to the growing number of medical spas, identified by experts as one of the biggest new trends in the industry?

Actually, I am very wary of this trend. I think that before we start analyzing the statistics, we have to define what a medical spa is. And I don’t just mean for ourselves: there should be international legislature so that the consumer knows what they’re dealing with. For instance: a medical spa in Europe means something entirely different than it does in the U.S. I personally don’t think that a place that performs surgeries should be called a spa. It’s a clinic. A spa is a place where you have therapists; it doesn’t mean that they cannot be top-trained medical professionals or nutritionists and psychologists, but the focus at a spa is wellness and health and balance, not invasive procedures.

What are other concerns of yours when you look at how the spa industry has developed?

The biggest challenge going forward will be finding qualified people and training them. As a therapist, you have to know the anatomy and physiology and all the muscle groups; you have to understand the basis of what you’re doing in order to deliver therapies that work; and there are so many out there that make no physiological sense. At ESPA, we have a special school where we train all our staff. Education is key to avoid having huge variables in standards. But there’s a long ways to go: in the U.S., for instance, half of the 50 states don’t have any qualifying requirements to work in a spa. That’s just unthinkable.

You’ve opened ESPAs all over the world, including Russia, Japan, China, France and Italy. What are the challenges and rewards in working internationally?

Obviously all the spa cultures in these places are very different from one another. We try to honor local traditions and to incorporate them into the design of the spa and also the treatments. We also try to recruit locally as much as we can, which also involves a lot of educating. In Bali, for instance, there is no school for therapists, so they know the local treatments very well but have no background in physiology, so doing a Western-style facial becomes difficult. Ultimately, you also have to realize that you can’t be all things to all people. I think it’s better to do a simple menu that can be delivered very well and with the highest of standards.

What are some of the best spas you’ve discovered during your own travels?

I have to be honest: I try new places less and less, because I am so frequently disappointed. Generally I seek out treatments if a specialized therapist or someone with a deep cultural knowledge will be performing them. I had an amazing Ayurvedic treatment at the Ananda in the Himalayas. I also have had incredible cupping massages in Beijing and was impressed by treatments that incorporated vibrations, by using bells and gongs, in Tibet.

What advice would you give a potential client who is trying to figure out what spa is right for him/her?

Don’t be afraid to ask a lot of questions. Ask about the qualifications of the therapist, how long they’ve been qualified and where they trained. Ask what you should bring along. Ask questions about the menus, which are often written by marketing departments and tell you little about the actual treatments. Ask if upon arrival someone will be available to go over your personal needs? If you’re going overseas, ask about separate sex steam rooms, saunas etc. and if you’re concerned about having a therapist of the opposite sex, be sure to inquire, as especially in eastern Europe, Germany and France, there are a lot of male therapists. Figure out the tipping procedures first, because this can add unwanted stress to a spa experience. And try to give it to the therapist directly, since you don’t know what happens to it if you add it to the bill. Finally, know that if you feel uncomfortable, you’re absolutely entitled to leave.

Read about Harmsworth’s favorites, including destinations, travel rituals and restaurants tips around the world.