In the first installment of this article, we investigated the importance of familiarizing clients to a suitable frequency and duration of treatment (steps 1-3). This article concludes our review of this topic with the final 4 strategies for improving client retention.
4) Don’t Practice a Strict “Disorder Model” of Care
Counseling isn’t just about mental illness and psychological disorders. It’s about helping clients to live exciting, fulfilling lives.
Over the last 30 years, counselors have become focused on a very medical model of care, where treating/resolving a diagnosable mental disorder is the goal of treatment. This approach has paved the way for “life coaches” (usually providers without the clinical expertise and training of licensed counselors) to walk on the scene and become the new “people helpers” of choice. Somewhere, Carl Rogers is rolling in his grave.
If your clients are alive, they are changing, and they are growing. Even the lives of the healthiest persons have stress, difficult challenges, and can benefit from support and counseling.
Wacky Counselor Statements:
- “We had little to talk about in therapy this week, which tells me that we must be finished with counseling.”
- “When it seems we’re not making progress after a session or two, I suggest clients take a break from counseling.”
5) Break the “See you Next Week” Mold
This seems like common sense, but many counselors are so used to seeing clients once a week (or every other week) that the idea of seeing a client 2, 3, or more times in a week sounds like Spanish (or extortion) to them.
The truth is, you probably have clients who could genuinely benefit from more than one session a week, especially (but not limited to) clients at the beginning of treatment. If you’re like many of the counselors I consult with, perhaps you haven’t even offered this!
Wacky Counselor Statements:
- “None of my clients want to see me more than once a week.”
- “I’m not a psychoanalyst. I can’t see clients more than once a week.”
6) Don’t Terminate Too Early
Recently, I was supervising a therapist who had a client presenting some commitment issues. The client had been dating a woman for a number of years, and while he loved the woman, he feared taking the next step toward marriage.
I was surprised when just a couple weeks later, the counselor I was supervising reported that he had terminated therapy with the client, as they had completed their therapy goals. The supervisee explained, “We talked about it in session, and he’s over his commitment issues. He says he’s ready to move forward.”
“Really?” I said. “Did he buy a ring?”
“Um. No.”
“He’s proposed?”
The supervisee laughed in spite of himself.
“Haha, no. I didn’t think of that. Maybe we’re not done after all.”
This client wasn’t finished with counseling—he was just getting started! Counselors need to remember how important client action is to completing treatment, and that there’s going to almost always be regression as a part of growth progress. Surely, this client was likely to have new feelings of anxiety when he began to take actions toward establishing a more committed relationship.
When counselors terminate therapy too early, the message to the client is, “You should be better now. If you’re not—maybe there’s something seriously wrong with you that counseling can’t help you with.”
Wacky Counselor Statements
(See counselor’s half of dialogue above.)
7) Follow Up With Clients Who Have Lost Touch
Last but not least is the issue of following up with clients after they have left or “completed” care.
There are a lot of reasons that counseling treatment can get interrupted: Seasonal illness, vacations and holidays, scheduling problems, car trouble, work conflicts, etc.
When clients get out of the habit of coming in for counseling, it can spell the end of treatment. For example, have you ever gone to the gym consistently, only to have your routine broken by some external event? It can take a long time to get back on the treadmill.
I have found that counselors are very reluctant to call clients. They worry that they will be bothering their clients, violating their sense of privacy, or that they will seem pushy. I have found that this is almost never the case. In fact, the opposite seems to be true. When it’s sincere, clients deeply appreciate getting a phone call from their “doctor” (and as their counselor, that’s you).
I can recall numerous instances where counselors I worked with were literally terrified to follow up with a client by telephone. We often had a good laugh when they finally overcame their fear, dialed the phone, and was profusely thanked by their client for the call (and rewarded with a new appointment on the books!).
Don’t worry about being seen as insincere, because you’re not! You’re a caring and thoughtful therapist, who wants to reconnect with your clients to promote their success. Also, consider this: your client usually pays to talk with you. Now, you’re calling to talk with them at no charge—how is that not fantastic?
A simple call like this will suffice:
1) Say, “Hi [Jamie] this is [Anthony, from Thrive]. I’m calling because I haven’t seen you since the [winter storm], and I wanted to see how you’re doing.
2) [Active Listening to client response].
3) Say, “When we left off, we were making progress toward our treatment goals, but were not yet finished. Shall we get started again this week?”
Wacky Counselor Statements:
- “I’m worried that a phone call would be a nuisance to my clients.”
- “My clients will be ‘creeped out’ if I call them.”
- “My client is an adult and should call me if he/she wants to continue seeing me.”
“Win-win” is Not a Dirty Word
Will it benefit you if your clients come to counseling more regularly, and have more sessions with you? Absolutely. You might even grow a full and profitable practice. Will better client retention improve treatment outcomes for your clients? Without question it will. It’s a win-win.
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Anthony Centore
I agree with calling clients when they cancel or no-show your appointments. Most appreciate; other’s dont’ call back. What do you do with clients who come with an agenda? For example, one client came in only to get a letter from me stating that her father could not visit her anymore. I told the person I can’t do that after meeting for the first time. I explained the counseling process. She never returned and told me later on via telephone (I contacted her) that her daughter got a letter from her doctor instead.
Hi Robin,
Thanks for your comment (and question)!
Every once in a while we’ll get a client who wants something really specific, but that isn’t really therapy — such as your example with a client wanting a letter.
I (personally) will often write a letter upon request, but I tell the clients what I’m going to write–and it isn’t always exactly what they want me to write. For example, in this situation, I might write that I had spent exactly 1 appointment with the client, who reports stress and anxiety about visits with her father. However, I may also note that the client has no signs of a diagnosable psychological disorder, there is no evidence of child abuse, and that her relationship problem with her father might be a child-parental conflict common in teenager-parent relationships. I might suggest that while the client desires not to see her father, an alternative solution may be to have them participate in family therapy. —Robbin, this is all conjecture, as I don’t know the exact situation. As for “keeping” this client, it seem the only way that would happen is if she had such an unexpectedly powerful experience in the first session that she decided counseling was something she wanted to continue with (even though it’s clear, she wasn’t interested in ongoing sessions when she arrived). I hope this helps!!
I have a rule….I call 3 times for follow up within 90 days, and leave a message if I don’t reach my client with whom we fell out of touch. In my message I encourage him/her to call back, to pick up where we left off, or at least to let me know what’s their plan in regard to their treatment plan. Some will call, and come back, some won’t. If, I don’t hear from them, I will close the file after 90 days of no contact.
Is there anything else I could say to encourage them to come back and continue with counseling?
Helen,
I think that is a good approach. Follow ups tend to be very helpful for counselors and clients. Client appreciate them! Counselors, on the other hand, often don’t do follow ups because their too busy, or feel uncomfortable with the idea (it’s a good idea to tell clients you will follow up by phone during the informed consent process).
Anyway, sometimes emails or letters to clients can help in leu of calls–but you’re definitely on the right track!!