If you’re like most, when you start a private counseling practice, you’re a bit nervous about whether you’ll get enough clients in the door. Whether you’ll be able to stay in business—perhaps whether you’ll be able to buy groceries—depends on whether or not there are clients sitting on your couch. During such times, you’ll be tempted to serve anyone who reaches out to you. For example:
A potential client will ask: “Can you help me with my panic attacks?”
And, with limited experience, you’ll say: “Indeed! I’ve worked with clients struggling with a variety of anxiety issues [just not panic attacks]!”
A client might present night terrors, vaginismus, narcolepsy or something you’ve never even heard of, and you’ll want to find some way to help. You won’t cross ethical lines, but you’ll definitely be outside your comfort zone. Maybe you’ll help a guy who pays cash but won’t give you his real name (Red flag? What red flag?).
One counselor I worked with, Dr. Mike*, conducted sessions into the small hours of the morning to help taxi drivers and prostitutes who couldn’t come in until after midnight. It was good work but didn’t fit in his life as he had young kids who needed their dad awake during the day (Also, Dr. Roy had the softest couch in the office and each night Dr. Mike would eventually pass out on it. Dr. Roy would track him down the next day and say, “Mike, lay a sheet down or something, you’re getting your face oil and night sweat all over my couch!” It was the good old days, but I digress).
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, especially when you need the clients)! Until, that is, you realize it’s killing you, and it’s no picnic for your clients either.
A Two-Way Selection
Not every client is going to be a good fit for your practice, and you’re not going to be a good fit for every client. The company, “Big Ass Fans” knows this as it applies to customers. They make excellent fans, and employ more than 200 workers, but they know their cheeky branding doesn’t appeal to everyone. In fact, they have a hilarious collection of angry voicemails from offended would-be customers telling them as much (animated, on YouTube, I highly recommend them: “You put profanity in my mailbox…Isn’t there anything else you could call your company? This is what’s wrong with our society!”) Since they lead with what makes them different, the customers they do acquire are a better fit. Persons who offend easily know right away that they’re best to find another manufacturer.
While I’m not recommending you name your practice ‘Big Ass Counseling,’ (that would be fantastic though) making your identity clear means that you’re going to acquire clients who are consistently a better fit for your practice.
At Thriveworks, even though we’re in the same communities as other mental health centers (80+ locations nationwide), not to mention accept many of the same insurance plans and provide relatively similar clinical services, our counselors consistently report that the clients we help 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 unique processes that we believe influence the type of client who selects our services, and the type of client who self-selects away.
- 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 the position: “this might be outside our scope, but let’s give it a shot anyway.” This isn’t to say that practices mislead clients into choosing them. When a client calls for an appointment, he or she wants to schedule that appointment!
Once upon a time a client called us, asking to schedule with 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. Instead of selecting another day, the client asked to be scheduled with any counselor who could see him on a Tuesday. So, against our better judgement, we scheduled him with a very experienced general counselor. Soon after the appointment the client wrote a negative online review because—you guessed it—he felt that the counselor didn’t know enough about sleep disorders!
It was out fault. We never should have scheduled the client with a provider who didn’t specialize in his presenting issue. We apologized. We refunded his money. We tried to refer him. Nothing helped. Years later, that negative review remains. By not making sure it would be a good fit, we created a situation what was bad for the client, and bad for us.
- 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 their session.
We used to have a “hazing” for new schedulers. In his/her first week, he would predictably receive a call from a potential new client who would say that he/she didn’t “feel comfortable” giving a credit card over the phone. The scheduler would plead with a manager, “This person promises she’s going to show for the session, and I believe her!” We’d allow the appointment to be scheduled, and nearly 100 percent of the time the client would no-show.
- 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 gets sick, their car breaks down or they need to work late, and if they don’t give us at least 23.5 hours’ notice, we’re charging them!
There are no freebies. Our counselors need to pay their mortgages. While many potential clients appreciate this, others don’t. We’ve had potential clients ask “What if someone dies? Would I still need to pay?” To which we might respond, “Yikes bikes! are you expecting someone to die within 23.5 hours of your session?”
We’ve had clients walk out before beginning their first session (during the consent process) because they felt the policy was too strict. That’s okay. It’s better we realize that it’s not a good fit at the beginning than at some later time when we need to charge for a missed appointment.
- Required Information
On the first call, prospective clients need to provide schedulers a considerable amount of information, including their home address, email address, insurance card number, date of birth and several other demographics. This is necessary for us to confirm benefits before the first session. This process takes too long for some callers, 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 an impact.
- Family Can’t Schedule for You
Unless it’s for a minor child, a friend or family member can’t schedule a first-appointment, even if they’re willing to pay cash in advance of the session. We don’t go anywhere near this type of situation. At least for us, it seems to get messy, fast.
Here’s what happens: The adult child, spouse or friend attends the session that was scheduled for them, but he/he loathes it and doesn’t continue. Or, more often, the would-be client who didn’t schedule their own session chooses not to attend at all, and the initial payer calls back demanding a refund.
One way or another, it wastes everyone’s time.
- Being Unapologetically Us
Until recently, if a client called our scheduling line and was waiting in queue, every 20 seconds a recording said. “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. Every once in a while, I’d have a scheduler run into my office and say, “AJ, we just lost a client because of that message! The person said he/she would NEVER go to a counseling practice that uses the word ‘HATE’!”
And I’d say: “That’s okay. We use the word hate sometimes. If that’s a deal breaker for the potential client, then it’s lucky they got to learn that about us early.”
Starting a Client Relationship
Bottom line: Building a practice isn’t about getting clients in the door; it’s about getting the right clients in the door and building relationships with clients that you are best qualified to help, and who are compatible with your counseling practice.
*Names changed, of course.