Whether you’re 6 or 60, there’s one thing everyone hates when going to the doctor; and no, it’s not getting pricked with needles. It’s waiting to get pricked with needles. Your appointment is at 2, but as 2, 2:05, 2:10 rolls by, you ruminate “I had an appointment. If the doctor wasn’t going to be available, why schedule at this time? Apparently, my time isn’t valuable.”

As our lives are perhaps more rushed than ever, waiting for any appointment or meeting is a hassle. However, a tardy counseling session is qualitatively worse than other late meetings. Getting started late is a broken promise in a relationship that needs trust in spades.

We’ve polled our clients. Sessions starting late is their #1 complaint. Think about that. It’s not clinical care, it’s not parking, it’s not price. It’s timeliness. Thankfully, it doesn’t happen often.

Start on Time

When possible, start the day early. Arrive at least 20 minutes before your first session is scheduled to begin. When your first client arrives, begin the session. You might gain 2 minutes, you might gain 10. Explain what you’re doing and why: “John, would you like to get started early? Great, this will help me stay on schedule today. Okay, we’re starting at X, which means we’ll end our session at Y.” After that session, look for times throughout the day where you can pick up minutes. If the next client arrives early, see him/her early as well. Repeat this anytime you can; after lunch, or if you have a gap between sessions.

Resist the temptation, after a session, to sit in your office until the top of the hour. I know that temptation! At Thriveworks, our clinicians, in their desire to provide better service, decided to hold themselves accountable by posting a sign in the waiting room for all to see that says “97%+ sessions begin on time or early.” They did this because they know (as we all do) that we have the best of intentions, until we’re tired. Then the desire to zone out for a few minutes overpowers our commitment to see our clients on time (Note: I’m not saying to become a machine. If you really need more time to rest between sessions, book fewer clients, or schedule breaks between your sessions. That’s okay!).

And that brings us to the next thing. You’ll never be able to start on time if you don’t end on time…

End on Time

Ending on time is difficult. I’ve witnessed new counselors run over when they feel like they haven’t “done enough” in session. Even seasoned counselors can run late with talkative clients, because it’s a challenge to cut them off. The difficult truth is that when a client leaves a session often things are left unresolved. If you had another hour, you’d be able to make more progress.

However, if you don’t end on time you won’t have time to write your notes after the session–and that is the very best time to do them. Immediately after, the session is clear; clearer than it will ever be. And as tired as you might feel after a session, it’s nothing compared to how tired you’ll feel at the end of the day, which is when many counselors try to do their notes. For me, at the end of the day, notes that should take 30 minutes take hours to finish.

Let clients know that if they arrive late, you still need to end on time. This rule isn’t fun or easy to enforce, which is why the first time a client should hear about this is during a thorough informed consent process.

Lastly, ending on time is imperative if you want to keep the doors open. We’d all like to have more time in session, but if UBH pays for 45 minutes, giving an hour (just 15 more minutes) means 25% of your time goes unpaid. Reimbursement rates simply aren’t designed to allow for such an overage. This too is a difficult truth. The silver lining is that while you can only provide one service a day you can provide a service every day, meaning clients who need more time can opt for more than one session a week–and that is covered by insurance.

A Difficult Discipline

Running sessions that start on time (or early) and end on time is good for you, and good for your clients. An interesting factoid: While we’ve received complaints that sessions have started late, we’ve never once received a complaint that a session ended on time. What do you think about starting/ending on time? Let me know @thriveworks or @anthonycentore.

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