Letting the Right Ones In
When you start a practice, you need clients in the door. Whether you’ll stay in business—perhaps whether you’ll be able to buy groceries—depends on this. In these times, you could be tempted to push your level of training or competency to its limits.
A client will ask: “Can you help somebody with bipolar disorder?”
And you’ll say: “I’ve worked with clients who’ve had various depressive disorders.”
A client will ask: “Can you help me with my panic attacks?”
And you’ll say: “I’ve worked with clients struggling with a variety of anxiety issues.”
A client will present night terrors, vaginismus, narcolepsy or something you’ve never even heard of, and you’ll try to find some way to justify your general counseling experience as competency to help that client. What’s more, you’ll stay late at the office to help a taxi driver who can only come in at midnight. You’ll help a client who pays cash, but won’t give you his real name.
You might start to feel like the Statue of Liberty — bring me your huddled masses (because it feels wrong to turn away someone in need)! Until, that is, you realize it’s killing you — and it’s no picnic for your clients either.
A Two-Way Selection
Acquiring clients needs to be a two-way interview process.
While I’m not recommending you name your practice ‘Big Ass Counseling,’ making your identity clear means that you’re going to acquire clients who are consistently a better fit for your practice.”
At our practices — even through we’re in the same community as other mental health centers (we now have nearly 20 locations between Cambridge, Massachusetts, and Austin, Texas), accept the same insurance plans and provide similar clinical services — our counselors consistently report that our clients are qualitatively different from clients they’ve served at other outpatient practices.
The reason? Our clients are reliably a good fit for outpatient psychotherapy, especially our flavor of outpatient psychotherapy.
Below are some never-before-revealed processes that we believe influence the type of client who selects our services, and the type of client who self-selects not to purchase our services.
A Clinical Fit
Clinically, if we’re not sure a client is a good fit, we tell the client! Then we refer. Too many counseling practices take a “this might be outside our scope, but let’s give it a shot anyway” approach, and often it’s a terrible fit for both the client and the practice.
For example, we had a situation where a client wanted someone who specialized in sleep disorders and was available on Tuesday evenings. While we had a sleep disorder specialist on staff, she didn’t have openings on Tuesdays.
We refunded his money. We apologized. We tried to refer him. Four years later, that negative review remains.
Bad for the client. Bad for us.”
A Culture Fit
We also have some administrative processes that influence the type of clients who schedule a first session.
1. Credit Card Deposit
To confirm a first session, every new client needs to place a credit card or bankcard on file as a deposit. We see this as a reasonable benchmark to determine a person’s seriousness about coming for the session.
We used to have a “hazing” process for new schedulers. In his (or her) first week, he would receive a call from a potential new client who would say that she (or he) didn’t “feel comfortable” giving a credit card over the phone. The scheduler would plead, “The person promises she’s going to show for the session, and I believe her!” We’d allow the appointment to be scheduled, and with nearly 100 percent accuracy the client would no-show.
2. Consent for No-show Fee
When it comes to our late cancellation and no-show fee, we don’t just get signed consent — we get true understanding and agreement from clients. We tell clients that the day will likely come when their kid get sick, their car breaks down or they need to work late, and if they don’t give us at least 24 hours notice, we’re charging them! There are no freebies.
We’ve had clients walk out before beginning their first session because they felt the policy was too strict. That’s okay. It’s better we and the client realize that it’s not a good fit at the beginning than proceed and later there be hard feelings when the client starts missing sessions.
(NOTE: we’ve had some of those same clients come back later, okay with the terms, after realizing they prefer our standard of care to our competitors.)
3. Required Information
On the first call, prospective clients need to provide schedulers a considerable amount of information, including their address, insurance card number, date of birth and a few other demographic qualifiers. This is necessary for us to confirm benefits before the first session. This process takes too long for some callers, however, who opt not to schedule.
We don’t know exactly how that affects the selection bias of clients who use our service, but we suspect it makes a positive impact.
4. Family Can’t Schedule for You
Even if a family member is willing to pay cash in advance (unless it’s for a minor child) we don’t touch this type of situation.
It gets messy, fast.
The adult child, spouse or friend attends the first session, but loathes the fact that he/she is there — and doesn’t continue. Or the client chooses not to attend, and the payer demands a refund.
One way or another, it wastes everyone’s time.
5. Being Unapologetically Us
When a client calls our company, every 15 seconds there’s a recording that says. “We hate being on hold as much as you do,” and then gives the caller the ability to hang up and have us call them back when it’s their turn in queue (the total wait is usually under one minute).
Every once in a while, I’ll have a scheduler run into my office and say, “Anthony, we just lost a client because of that message! They said they would NEVER go to a counseling practice that uses the word ‘HATE’!”
And I’ll say: “That’s okay. We use the word hate sometimes. If that’s a deal breaker, then it’s good fortune that the potential client got to learn that about us early.”
It’s Not about Making a Sale, It’s about Starting a Relationship
Many people first try to “make the sale” or “schedule the session,” and only later begin to discuss terms, conditions, boundaries or fine print. This, of course, leads to a certain number of problem relationships.
Building a practice isn’t about getting clients in the door; it’s about getting the right clients in the door — ones where there is a mutual good fit for the practice and the client.”