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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Dr. Anthony Centore

Anthony Centore, PhD

Anthony Centore, PhD, is Founder and Chair at Thriveworks — a counseling practice focused on premium client care, with 340+ locations across the US. Anthony is a Private Practice Consultant for the American Counseling Association, columnist for Counseling Today magazine, and author of "How to Thrive in Counseling Private Practice". He is a multistate Licensed Professional Counselor (LPC) and has been quoted in national media sources including The Boston Globe, the Chicago Tribune, and CBS Sunday Morning.

Check out “Leaving Depression Behind: An Interactive, Choose Your Path Book” written by AJ Centore and Taylor Bennett."