6 Reasons You Don't Have Enough Clients

Getting and keeping clients is a common struggle for private practitioners. Here are 6 potential barriers to a full practice and what to do about them.

1) You're not keeping the clients you have

It takes a lot less time, money, and energy to keep a client engaged in meaningful therapy than to find a new client. Keeping clients engaged in the therapeutic process requires additional skills. New skills might include setting expectations during the initial session that therapy is an on-going process. Recommend  that new clients schedule ahead 3-6 weeks (depending on your assessment of their need during the first session) instead of scheduling one week at a time.

Another strategy that will boost client retention is reaching out to clients who've dropped out of treatment without proper termination. I encourage my team of therapists to do this regularly by writing a hand-written card with their business card enclosed to clients who have not returned to therapy. The cards say something like, "You've been on my mind. I want you to know that I am here if you need me. If you'd like to take a break from therapy for a while that's fine. I'd like to offer you a free 25 min "wrap up" session where we can say goodbye." Many clients are very touched by this gesture and it is just the encouragement they need to continue coming to therapy. Even if clients don't continue in therapy, you've modeled how to say a healthy "goodbye".

2) You're not offering anything valuable to potential referral sources

I love that I'm approached regularly by a therapists trying to network and ask for referrals. You know the ones who I will refer to? I will refer to the therapists who approach our relationship as a mutually beneficial relationship. I am more likely to refer to therapists who, in addition to asking for referrals, offer their time, expertise, or referrals to me and my practice.

Several years ago I had a therapist contact me asking if I would refer couples to her for therapy. While she did offer to take me to lunch (which I didn't have time to do) she wasn't offering herself as a resource to me in any way. Additionally, I was annoyed because had this therapist had done her homework and looked at my website she would have seen that I work with couples and that I have several colleagues at my clinic who also work with couples. The key to developing strong referral relationships is to create mutually beneficial relationship, offering yourself as a resource to the other person.

3) Your online presence is weak

Have you Googled yourself lately? Have you searched for key terms in your geographic location to see where your website ranks? Potential clients are searching for therapists online and will generally click on websites listed on the first page or two of Google searches. If your information is easily found make sure the information found about you and your practice is accurate. Here are some resources to help you strengthen your online presence and make it easier for new clients to find you.

Does Google love your therapy practice? 5 elements of an effective practice website 4 reasons to start creating online content

4) You're not as good as you think you are

Most therapists think they are more effective than they actually are.  Therapists, like any other professionals have varying level or skill and success, but it seems that on the whole we are an overly-confident group.

A 2003 survey asked 143 counselors to grade their job performance on a scale from A to F... Of the counselors, 66 percent rated themselves as A or better. None saw himself or herself as below average (Sapyta, Riemer, Bickman, 2005, p. 147).

How do you find out if your clinical skills are above average, mediocre, or below average therapist? Start collecting outcome data from your sessions. A few years ago I tracked every session using the ORS and SRS rating scales for an entire year through MyOutcomes.com. This allowed me to establish a baseline, track each client's progress, and see where your scores fall compared to therapists around the world. I was relieved to know that according to these ratings scales I was indeed an "above average"  therapist, but I was not as good as I thought I was.

5) Your attachment style is sabotaging you

A therapist's own attachment style and relationship history impact their ability to keep clients engaged in meaningful therapy and maintain consistent referral sources. While I only have anecdotal evidence, my experience training therapists in a private practice setting suggests that therapists with a secure attachment style or slightly anxious attachment do better in private practice setting than therapists who lean toward the avoidant end of the attachment continuum. Additionally, if therapists have done their own work in therapy and have a handle on their own issues, they tend to be more successful than therapists who haven't resolved their own emotional wounds. If you're having a difficult time getting or keeping clients, may I suggest calling your own therapist and working on your own attachment issues?

6) You appear desperate

Therapists who are new to private practice may feel particularly overwhelmed by the details of running a business, and the difficulty of establishing a consistent clientele. Feelings of desperation are also felt by seasoned therapists whose client numbers ebb during seasonal changes, economic conditions, or other reasons.  Potential clients and referral sources can "sniff out" desperation, and whether they are consciously aware of it or not, they will be less likely to trust you and your services. Here are some questions to ask yourself to see if you're coming off as overly desperate.

• Have you become  too accommodating when it comes to scheduling clients?
• Do you feel overly discouraged if a new referral chooses not to schedule with you?
• When talking about your practice do you talk fast and feel anxious inside?
• Do you follow up with potential referral sources more than once a month?

I suggest  that you "act as if" and "talk as if" you have a moderately busy practice. Lead with the aspects of your practice and your expertise that you are confident in and you'll find more success getting and keeping clients.

References:

Sapyta, Jeffrey, Manuel Riemer, and Leonard Bickman. “Feedback to Clinicians: Theory, Research, and Practice.” Journal of Clinical Psychology: In Session 61, no. 2 (2005):145–53.

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Pregnancy in Private Practice: 4 Key Questions To Help You Prepare For Maternity Leave

4 key questions to help you prepare personally and professionally for managing maternity leave in private practice.

I'm a mother of four children. My first two children were born during my educational journey and my last two were born while I was in private practice. Being in private practice provides many perks for balancing work and family life. The flexibility of being my own boss has been wonderful. However, taking time off for extended periods of time, like maternity leave, can prove to be tricky.  Unlike working for an agency, in private  you don't get paid leave in private practice,  you still have expenses to pay even when you're not seeing clients, and you have unpredictable income as you "wind down" to take time off and then build your client load back up after taking family leave.  Becoming pregnant while in private practice and planning for the new addition in your family requires some extra planning, coordinating, and saving.

How Much Time Will You Take Off?

These little babies can be a BIG adjustment. It's important to really think about taking enough time for you to adapt to being a parent to this new, little person. Dr. Jennifer Fee, psychologist from California found that one of the most helpful things was taking sufficient time off after giving birth. She suggests coming back gradually and not carrying a full load for awhile.

"Rushing back [to work] while you're adjusting to and bonding with a new baby is not good for you, your baby, or your clients. The great thing about private practice is that it's not an 'all or nothing' business. You can start practicing with a few clients rather than jumping back into a full load," says Dr. Fee.

Determining the length of your maternity or paternity leave can be extremely important in keeping your practice thriving. If you are a sole practitioner, taking a three month leave could potentially leave you with very few clients upon your return. You must decide not only how long is financially feasible but also how long works for your family and your clients.

Who will provide services to your clients in your absence?

It's important to consider who will provide clinical services to your clients while you are on maternity leave. If you are in solo practice, consider reaching out to another trusted private practice colleague who has openings to provide services to your clients while you are on leave. Make sure that your clients have the contact information of the therapist who'll be covering for you. I suggest that clients in crisis have appointments set up with this therapist before you take time off.

I recently talked with a private practice colleague who is pregnant with her third child. I suggested that she consider hiring another therapist to cover her clinical cases and also to generate income for her practice while she is on maternity leave.

When will you stop taking new clients?

You'll also want to think about when you will stop taking new clients. If you plan on taking new clients up until your leave I suggest that in your first conversation you inform them that you will be taking time off so they can have the option of seeing someone who can provide uninterrupted services.

Jennifer Venable-Humphrey, LCSW of Social Work Solutions stopped accepting new clients one month before her due date. When put on bed rest with her third child, Jennifer used Skype or phone sessions to check in with current clients that she had to stop seeing earlier than planned.

How will you cover your fixed expenses and lack of income?

Taking time off in private practice is tricky because you have to plan not only for lost income but for paying the fixed expenses of maintaining a practice while you are on leave. Expenses like rent, phone, internet, or perhaps the cost of support staff may need to be paid whether you are practicing or not.

Joseph Sanok, LLP, LPC of Mental Wellness Counseling in Traverse City, MI suggests considering the cost of being away from your family once you have returned to your clients. Sanok decided to increase his fee when his wife became pregnant. "For me, I knew that working in my practice was going to be difficult when I had the draw of a wonderful new addition. By raising my rates, it made it easier to give up the time."

I'm curious to learn more about the changes you made or creative ways that you found for your transition to parenthood in your private practice. Share those here!