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Growth by Reduction.

Running a private psychotherapy practice can be hard. Let’s face it, behind the rewards of helping clients resolve complex issues and the freedom and flexibility you get from working for yourself, there are many profound challenges to running a successful practice. One of the more common issues faced by both new and experienced clinical social workers alike, is consistently getting enough clients to make a decent living. So, if you struggle with maintaining a full schedule, you can at least take solace in knowing that you’re in good company.


Of course, there are many different reasons why the green light (indicating your next client is in) is dim more than you’d like. Perhaps, it’s that you’re having trouble getting noticed amongst the sea of other well-qualified and experienced therapists in your area. Possibly, it has to do with limitations imposed by insurance on the number of visits allowed, or because your website doesn’t rank high enough in searches. Maybe, a general decline in talk therapy as a stand-alone treatment is contributing to the shortfall. These are all undoubtedly significant obstacles. Another critical and often overlooked factor though, is attrition.


When clients decide to end therapy early, it can create an unexpected, sizeable hole in your schedule. Early studies of attrition pin premature dropout rates at between 20-57 percent, while more recent research suggests that somewhere between 30-60 percent of clients leave early. There are many justifications for premature termination but one of the most commonly cited explanations is “dissatisfaction with the therapist”. Hearing this type of feedback can be jarring, hurtful, frustrating, and even ego-shattering. But, from a business perspective, dissatisfaction with your services (as opposed to some external factor that you have no control over) is a variable you can do something about. If you’re open to hearing the reasons why some clients decide to terminate treatment with you, and equally as open and committed to making adjustments to your approach, technique, experience, etc., you can limit the number of clients that will leave therapy early in the future. Although it might be difficult to hear, understanding the specific reasons why your clients end therapy precipitately can radically help sustain your practice.


Start by asking existing clients about their experience at the conclusion of treatment to learn if there’s anything you can do better or differently; but more importantly, take the time to reach out to those that stopped coming, and inquire why. If you’re not comfortable asking or don’t think you’ll get an honest answer, work with a consultant who is more likely to get candid reactions. By diving deep into your clients’ thoughts and perceptions about key aspects of your practice, you can better understand what clients think about your brand, practice style, approach, etc. and why they have those opinions. You can identify trends about your clients’ overall therapy experience and unearth critical insight into potential adjustments you could make to improve the experience for clients going forward.


While reducing attrition is clearly not the only way to increase your caseload, it’s one of the most efficient and effective ways. Remember, it typically takes considerably more effort and time to get new clients than it does to retain existing ones.




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