Are you struggling with client retention in your practice? What are some good tips on how to improve your client retention? How can you create a good relationship with clients from the get-go to encourage them to return?
In this podcast episode, Whitney Owens addresses the issue of improving client retention in your private practice.
In This Podcast
- What is retention?
- How are clients experiencing you?
- How can we improve client retention?
What is retention?
Client retention is the rate that you’re able to keep clients at your practice. So, how often are clients continuing their services with you? (Whitney Owens)
Due to a study completed in 2009, it was found that:
- 35% of clients do not come back after the first session, and
- 50% of clients do not show up after the third session.
This is something to think about with regard to your practice. Are your numbers similar? Then you are in the average, however, you can still work to improve these statistics.
Not only will you make more money if clients stay with your practice longer, but it is also important for the clients and their healing journey if they can stick to it and remain consistent in their therapy.
How are clients experiencing you?
When a client schedules at your practice, I encourage you to think about how much did that cost, and how many client sessions would that client need to attend to break even? To pay yourself, pay your expenses and to not lose money because you invested so much in acquiring them. (Whitney Owens)
This averages out to about four to six sessions, depending on if you are a cash-pay or insurance-pay practice.
You can share this information with your clinicians so that they know how important it is to work to retain any new clients, as well as encouraging their therapeutic treatment and forming strong relationships with them.
Most clients start to find relief from their symptoms after sessions spanning six to eight weeks. During this time, the clinician can learn about the family of origin and understand more of the root cause behind a client’s suffering.
This begs the question: why are clients leaving therapy too soon?
- They have a poor fit with their therapist. It takes about three to four sessions to see if there is a connection between the client and the clinician.
- They feel like their therapist was judgmental or not listening to them.
- Maybe the therapist lacks experience in dealing with the issue that the client is experiencing.
- The client underestimates the requirements and the commitment to therapy.
- Clients feel put off over long wait times.
How can we improve client retention?
1 – Emphasize the importance of educating clients on the experience of therapy before their first appointment and during the first appointment.
- This could be in person, or
- On your website
Let your clients know that therapy is a process, not a one-time occurrence.
2 – Try to schedule your clients for the same time every week
The client is more likely to remember the appointment, and this helps them view their therapy as a commitment when it has a fixed time and day instead of being sporadic or inconsistent.
3 – Make it very easy to schedule appointments
- Try to open up as many spots as you can, or open a group practice, so that you can make spots available to potential clients.
- Consider hiring an assistant who will handle the intake calls because they will be able to handle the phone all day while you see clients.
- Create a booking page on your website for clients to fill in.
4 – Problem-solve their financial problems
Think through their financial reasons: are they really not able to pay, or are they using money as an excuse to not show up to therapy?
- You could offer bi-weekly sessions.
- If you are cash-pay, you can offer superbills.
- If you are insurance-pay, you can discuss with them how they can pay through insurance.
- Discuss alternative payers such as through a church or another family member.
- Work through their finances with them, if they are comfortable, to see where they can free up extra money that they did not know they had.
As a therapist, just really watch that in yourself, especially in the first few appointments with clients, making sure that you are offering a safe and therapeutic experience for them to talk about whatever it is they want to bring to the table. (Whtney Owens)
5 – Follow up with your clients
If a client never responds to you or never returns, you may not know what the reason is, and it is best not to assume.
Reach out to them and see what it is that they need right now. Put this in the disclosure agreement at the beginning so that they know that you will contact them to check up on them should they stop coming to their therapy with you.
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Meet Whitney Owens
Whitney is a licensed professional counselor and owns a growing group practice in Savannah, Georgia. Along with a wealth of experience managing a practice, she also has an extensive history working in a variety of clinical and religious settings, allowing her to specialize in consulting for faith-based practices and those wanting to connect with religious organizations.
Knowing the pains and difficulties surrounding building a private practice, she started this podcast to help clinicians start, grow, and scale a faith-based practice. She has learned how to start and grow a successful practice that adheres to her own faith and values. And as a private practice consultant, she has helped many clinicians do the same.
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Welcome to the Faith in Practice podcast. I’m your host Whitney Owens recording live from Savannah, Georgia. I’m a licensed professional counselor, group practice owner, and private practice consultant. Each week through personal story or amazing interviews, I will help you learn how to start, grow and scale your practice from a faith-based perspective. I will show you how to have an awesome faith-based practice without being cheesy or fake. You too can have a successful practice, make lots of money, and be true to yourself.
Hi, welcome to the Faith in Practice podcast. So glad you’re here today. If you haven’t already, please take the time to rate and review this podcast on whatever player that you listen to it on. It means so much to me. I personally go in there and read what people write and encourages me to keep moving forward in podcasting and knowing what it is that you like so I can give you more of it. So please go and do that for me. I love hearing from you guys when you’re listening to the podcast, things that you do. You can also shoot me an email firstname.lastname@example.org. Would love to hear from you and how it’s helping you grow your practice.
So I did a solo show today about client retention, because I get this question a lot on how to help client retention, especially in a cash pay practice, because we find that retention can be a little bit lower in a cash pay practice sometimes because of difficulty with finances; but at least that’s what clients tell us sometimes. So it’s important that you work on your client retention. This is an area that is overlooked too often. We focus so much on getting clients into our practice. I mean you know that feeling when you get a call, “Oh, someone’s interested. I’m going to have to call them back as soon as I can.” We put a lot of focus on marketing our business, all the money and time we put in the front end, and then we get the clients and if they only stay for a couple of sessions, we sometimes lose money or it’s really not helpful for the client.
t’s a lot of energy on you. So one of the biggest drains on your practice is clients that don’t stay for the full time in treatment. So that is what the show is about today, how to improve your client retention. I think you’ll find it super helpful. I know in consulting with others, this is one of the hottest topics, and that’s why I did a show on it. Just did a consulting call about this very issue. So excited to share that with you today.
If you’re looking for more community and wanting to hang out with other faith-based practice owners, if you haven’t already go into Facebook and look for the Faith in Practice Facebook group. Would love to have you in there. We have a lot of people just throwing questions out there to help grow their practice and then I’m also active in there and answering questions, doing Facebook lives, helping other practice owners, because this is all about community. I know that being a practice owner can get lonely. Even if you have a group practice, it can still get kind of lonely. So having a community that thinks like you really is helpful. So check out that community. Anyway, I appreciate you taking the time to listen. We’re going to jump right into the episode and helping you improve your client retention in your practice.
So today I’m going to do a solo show on client retention. I love to come on here and do solo shows on topics that I get questions about, especially as a niche within the private pay world. People are always asking me, how can they make more money and how can they get there themselves or the clinicians at their group practice to see more clients or retain the clients that they’re already seeing. So I’ve got some tips on that and can explain what client retention is. We’ll talk about the problems with it and then we’ll also talk about how to resolve some of those issues as a private practice owner and also as a clinician. So first of all, this word retention we use often. So let’s actually define what that is.
Client retention is the rate that you’re able to keep clients at your practice. So how often are clients continuing in their services with you. In a research study back in 2009, we found that 35% of clients don’t come back after the first session. And then we also find that 50% of clients don’t show up after the third session. So some for you to think about as you look at your practice, if you find that those are what your numbers are, then you’re in luck because you’re with everybody else, I guess. But we also want to improve that of course. And if your retention rate is higher than that, so people are dropping out sooner than that, then that’s concerning. And then obviously if it’s better than that, that is awesome.
All right. So retention is really important because for lots of reasons, really here, so let’s talk about some of those. Not only is it for profit reason, you’re going to make more money when clients stay at your practice longer, but it’s also really important for the clients. Like we want them to have a good therapeutic experience. We want them to find success in therapy, to meet their treatment goals, and so if they’re dropping out of therapy early, they might walk away with a bad taste in their mouth, or they might still have the same issues or very likely are going to have the same issues that brought them in to treatment. So this is a really important topic for us to address. We found that all too often, not only counseling businesses, but businesses in general spend way too much time and money acquiring the clients, but they don’t spend a lot of time and money keeping clients in their business. They’re not focused on that enough. So really you’re draining your resources by marketing, pulling people in, getting them scheduled, but then having them leave, you’re wasting a lot of money there on the front end.
So I want you to consider, honestly, how much money does it take for you to acquire a client in your practice? And that could be how much are you spending in marketing when either yourself or someone else takes that intake call. That time is money. You’re paying somebody or you’re time is money where you could be seeing a client. How much time is that? And then you’re having to do that intake as a clinician and that’s super time consuming. There’s more paperwork involved, you’re doing a thorough intake exam, evaluation there and so you have different questions that you’re answering. You’re making a treatment plan for that client. So that’s your time and money as well. So a lot is going into it, you as a business owner, to be able to acquire that client into your practice.
Some other things would be the SEO work that you’re doing on your website, the social media marketing that you’re investing in, all the networking that you’re doing within the community to be able to get those good relationships, those good referrals going. So you have put so much time and energy into that. So let’s really examine how are clients experiencing you? How are they leaving your practice? Because this is a big money leak for you and your business. And of course we want clients to have good treatment outcomes, but I’m going to really talk a little bit more about the business side of this as we kind of move forward.
So when a client schedules at your practice, I encourage you to think about how much did that cost and how many client sessions would that client need to attend to kind of break even, to be able to pay yourself, to pay expenses and to not lose money because you invested so much in acquiring them. It’s probably about four sessions. It could be up to six or eight sessions. I do find that practices that are cash pay do have to put a lot more work into the marketing aspects and practices that are insurance-based do not have to put quite as much time and energy into acquiring clients because insurance can refer those clients to you. And that makes it a little bit easier. But think about that amount that you put into it, and then consider how many sessions does the client have to come to be able to break even in that.
And I think it’s important, especially group practice owners that this information I’m sharing with you, that you can share it with your clinicians because clinicians are focused on the client care as they should be, but they’re not thinking about the business side of things. I can say when I shared this with my clinicians and talked to them about this is what I have to put in to getting that client, if you can’t retain them, then it hurts the business, that was something they had never thought about. And they were grateful that I shared that with them. So something that you can think about in the principles that I’m sharing, if you’re a group practice, or you can use these in training your clinicians as well.
So we do see, another study that I researched back in 2017 through APA talked about 50% of people are better within that 15 to 20 session mark. So you’re looking at about the four month mark in treatment. Sometimes it’s a little less and sometimes it’s a little more. And then we do find for some more co-occurring, I’m totally messing up my words this morning. I need a second cup of coffee. So anyway, with these conditions where you have two things at the same time, or you have other things going on, they might need longer treatment. So they might need more like a 12 to eight month treatment program. So I know when I’m doing sessions, I tend to see that most clients find relief from their symptoms within about six to eight weeks. I actually specialize in working with anxiety and so I can do some good CBT, ACT, interpersonal therapy, all within that six to eight week mark and they start to find some relief.
And then at about that time, we start to notice a lot more of the family of origin issues that are bringing them into treatment. So then we start working on some of those types of things and really dealing with the root issue of their symptoms. So most of the clients need about four to five months of treatment. And I find that too, that they find relief and then we work on some more of the root issues. So something to think about. So the question here is why are clients leaving therapy too soon? Now there’s probably a lot more here that we can say, but here are the things that I suggest and found in my research and then we can talk about how to relieve those.
A lot of clients leave because they have a poor fit with their therapist. And we see that within about three sessions. You have a pretty good idea if this is something that you’re going to be comfortable working with or not. Maybe it’s that the personalities don’t match. Also clients do tend to say that they feel like their therapist doesn’t listen. I mean, you probably have heard this from clients as well. Whenever I do an intake, I always ask clients, have you ever been in therapy before? And if they have, I go deeper, tell me about that experience. What was it that took you into therapy? When did that happen and what did you think about your therapist and what did you like about your therapist? What did you not like? That will give me a bunch of clues as to how treatment is going to go with me. It’s probably going to go similar to whatever they said before. So if they said, yes, I’ve seen seven different therapists and I’ve only made it to three sessions because none of them fit, then that’s a red flag that they’re probably only going to see me for about three sessions.
But they also might say, “Hey, what I really like is treatment tools.” So what I really like is a place to talk about things. So then I can tailor the treatment to what their needs are and that will improve the fit with the therapist and the client, because we should be meeting the needs of our client, not meeting our own needs. I’ve also heard though, when people come in, when I say, how was there a previous therapy, it’s so unfortunate, and this is a two-sided issue, but they’ll say, “I felt like my therapist was judgmental or they didn’t really listen. Or they told me X, Y, and Z, and really, they had no right to be saying that already.” And we may have experienced that even ourselves in our own therapy where someone kind of speaks out of turn, or you’ve only gone to one or two sessions and they’re saying that.
I actually unfortunately see this a lot in Christian counseling where people went and saw a Christian counselor who maybe they’re living together out of wedlock and the counselor just immediately says, “Well, the Bible makes it clear that you’re not supposed to do that.” So then the client is like, “What?” Like, and doesn’t come back and they feel very judged in that situation. So thinking about ways as therapists to be loving and accepting. Now, I’m not saying we shouldn’t confront things with clients, because we should at some point, but we do it in a kind and loving way after we’ve built a strong therapeutic relationship with them. So the fitness of the therapist is a problem for people. Maybe they feel like their therapist is not accepting, not listening. The client doesn’t experience empathy from the therapist, or maybe the therapist lacks experience on the issue being presented in counseling. So these are all reasons why there’s a poor fit between the clinician and the client and that leads to them leaving therapy too soon.
Another reason they leave therapy too soon is the client underestimates the requirements and the commitment of therapy. So the client maybe doesn’t understand, oh, I’m supposed to come every week or, oh, I need to do this for several weeks. I thought I’d be better by tomorrow. They just don’t really get it and how therapy works. So then they dip out of therapy too soon because they don’t understand the commitment they’re making. Another one is long wait times. So clients feel an urgency. I mean, by the time they’ve called you for an appointment, they are in pain. They’re emotionally hurting and they need to be seen as soon as possible because all of us usually wait to make our appointments right, until we absolutely have to call and make the appointment.
So if you can’t get some money in for a few weeks or you see them for the first session, then it’s going to be a few weeks, they might end up going somewhere else, so getting out of therapy too soon or maybe they feel like the appointment time doesn’t work with their schedule even though we definitely think that clients need to revolve their schedule around us because you’re the professional and they are the client. But at the same time, we want to make availability for them. I know that if my daughter needs an appointment, it’s not like I call the doctor and say, “Hey, my daughter needs an appointment. But by the way, I can only bring her on Wednesdays between three and five o’clock, if you can make that work.” You might mention it but the point is, if the doctor says, “Hey, I have an availability on Monday at nine.” I’m taking that availability because my daughter needs to be seen.
And then as therapists, I think we feel like we’ve got to be flexible and change our schedules to meet the needs of our clients and that burns us out. So it’s important that we as therapists maintain our schedule, be as flexible as we can, but not bend over backwards where we’re burning ourselves out here. And then other reasons clients leave is financial reasons. They can’t afford to treatment. And we’ll talk about that in a minute. So let’s address these, how can we improve client retention at your practice? Number one here is the importance of educating clients about the experience of therapy before their first appointment and during the first appointment. You start this on the first contact. So that could be your website. Maybe you have a page about how to book and what your first appointment is like or what the therapy experience is like. Let them know therapy is not a fix cure, all for everything. You need to invest in the treatment.
We will invest in you. It’s a process. It’s not a one-time thing. Let them know, “Hey, most clients come in for about six to eight sessions before they find relief and they have to come every week. If you don’t come every week, it’s a lot harder to move forward with your therapist and to make the progress you want to make.” So we actually tell clients this on the intake call, after they say, they’re interested and they want to schedule. “Hey, I just want to let you know that we’re going to ask that you mentally think of this as a six to eight week commitment. It doesn’t mean you have to come if you don’t like it after a week. So don’t feel like you’re financially committing to that. But we’re asking that you would commit your time and energy and resources to six to eight weeks and that’s how you’re going to find help in your situation.”
So then when client comes in for their first session, the therapist is also saying, “Hey, I know that you are dealing with X, Y, and Z. Like you just shared about your anxiety, your sleep problem, your eating problems. Here’s how we’re going to address these.” So you’re giving the client hope, you’re giving them tactics to say, “Hey, here’s the skills we’re going to use and I think we need about six to eight weeks of weekly therapy for you to get that.” So you really given the client hope, you’re giving them strategy, they know that you’re an expert and they walk away strong. And they walk away with a plan and that’s so important. And that in that first session, you let them know what you expect from them and what’s needed to get better.
I also see this often with clinicians that they don’t do some of these other things that I want to encourage you to do to just make sure that you’re really serving your client well. When the client ends the session with you and you tell them how often they need to come in, if possible, try to schedule them at the same time every week. When you come at the same time, the client’s more likely to remember. You’re more likely to remember, and the client sees this as a commitment in getting better. Just like when you sign up for classes in college, I’m going to learn about this topic and I’m going to learn about it every Tuesday at eight o’clock. You’re saying to your client, every Wednesday at one o’clock, you’re going to work on your anxiety and it is going to get better because of your commitment level.
So try to get them to schedule the same time every single week, let them know that you’re full, that you’ve got lots of clients, but you want to honor them and you want to give them priority and ask them to make this commitment. If they don’t make the commitment, they may not be seen every week. And that’s their choice if they don’t want to schedule out, but they need to schedule out so they see the importance of it. Don’t let the client just leave your office and think, you say to them, “Okay, well get back in touch with me if you want to schedule.” Like when you go to the cardiologist, they don’t say, “Just reach out to me if you want to reschedule.” They say, “This is what I see is the problem. Here are the tests we want to run. Here’s when we’re going to do it.” You are the professionals so you need to be saying to the client, “Here’s the disorder that I think, or an idea of the symptoms. This is what I think is happening and this is the treatment recommendation I’m giving.”
Let them take that and roll with it. They will appreciate you for it. So be strong. You’re very trained in being able to help people in this. So that’s that first thing; we want to really educate clients on the front end of the process of therapy and the benefits of therapy and the goals and how they’re going to achieve those goals. We also want to make it as easy to schedule as possible. If clients are finding long wait times, then they’re going to go elsewhere. So try to open up as many spots as you can, or have a group practice where you’ve got other clinicians that have availability, but you want to make that as easy as possible for them to schedule.
Another thing to consider is having an assistant take your calls because they’re more likely to get the phone than you are because you’re with clients or allow clients to be able to text. So if they were able to text, they might be able to get in faster to get their appointments. Obviously you want to have a HIPAA-compliant ability for them to text. So you want to make it as easy as possible for them to get ahold of you, for them to reschedule their appointments, or having someone live to answer the phone. Or you could try an online booking option maybe for first time appointments or even for second, third appointments, appointments moving forward. Make it as easy as possible for them to schedule.
All right. Another tip here to improve your client retention is to problem solve their financial problems if we know that finances is an issue. Now I do think a lot of clients will say finances are an issue and that’s honestly a cop out because they don’t want to deal with whatever’s coming up for them. So you really do have to kind of think through what is the reason they’re saying this? Is it because they really aren’t able to pay, or is it just that they don’t want to keep coming and they don’t know how to tell me that. And that’s an important thing to decipher because that’s a therapeutic experience, them learning how to confront things and talk to somebody about that. But as far as the financial piece, there’s a lot of things you can do to problem solve and here’s a few of them.
You could offer bi-weekly sessions, especially if they’ve been seeing you for a little while and they’re getting better. Offer by weekly. That’s better than no sessions at all. If you’re a cash pay practice, you can talk about super bills, out of network benefits, have them check those, and submit those. Maybe talk to them about using their insurance. If you are paneled with insurance, they haven’t told you about their insurance yet, that’s something to discuss. There’s flex spending accounts, HSA accounts so that they don’t have to deal with all the taxes and that helps them save money. You could also talk about other alternatives payers. So maybe they have a church that they have a pastoral discretionary fund that’s willing to help pay. I know a lot of church members at some of the churches here will talk to their pastor about getting some help paying for services, or maybe a grandparent or another family member can help pay for services as well.
Or maybe talk to them about, “Okay, well, let’s, let’s discuss money management.” So maybe part of the therapy is how do you manage your money appropriately? Maybe they’re overspending or maybe they’re depressed. They’re spending more money on shoes than they should, or they’re manic. So kind of looking at, “Hey, here’s how money’s being spent. Let’s change some of those so we can get your priorities met if you will want to continue counseling.” And those that are private pay practices, it’s really important that you, as the clinician, feel comfortable talking about money with your client. I do find that a lot of clinicians feel uncomfortable discussing money. They have their own guilt about that. So I want to encourage you to explore that maybe in your own therapy or with your consultant, why you feel that way, but it’s important that you tell clients their treatment recommendations without being worried about them paying for treatment.
If a client can’t afford to come every week, they’re going to tell you that. They do not have to commit to it. So if you’re saying, “Hey, I want you to come every six weeks,” some therapists will say to me, “Well, I don’t know if that’s what they want, or they don’t have the money to pay for that. Or maybe they don’t want to pay for me every week.” Well, that’s a personal thing the counselors got to deal with. But if you don’t tell the client what to do, they’re not going to know what to do or even worse they might be offended that you don’t want to see them every week. So you need to be asking them, “This is what I need from you.” They’re the ones that set up the first appointment and if they can’t afford it, they can always turn that down. But make that recommendation that they come in regularly for therapy if they’re going to get better.
And you want to train your staff. Also work on this yourself. We talked about the problem of empathy, not listening to clients, judgment. So as a therapist, just really watch that in yourself, especially in the first few appointments with clients, making sure that you are offering a safe and therapeutic experience for them to talk about whatever it is they want to bring to the table and that you listen and that you’re loving and caring towards them.
And then lastly, here, another tip is follow up with your clients. If a client comes for one session, two, three, and then never responds to you or never returns, don’t just ignore that. A lot of therapists make the assumption of, well, the client didn’t like me or the fit wasn’t good for them. We don’t really know what the reason is. It cannot hurt to reach back out to that client and say, “Hey, I’m thinking about you. I’m concerned about you. Did you find another therapist? Would you like to return for therapy? What is it you need right now? Did you meet that treatment goal that you said when you came in that you have panic attacks every day? Did that stop? Did that get better?” Because that’s what we’re working towards.
So reach out and find out. I encourage you reach out two or three times. You don’t have to be expressive about it. It is good to put that in your paperwork, that when they come in for the very first session, you go through that disclosure statement saying to them, “Hey, if I don’t hear from you for a little while, I am going to reach out to you, I’m going to reach out to you two to three times. Don’t be surprised. It’s just because I care and I want to make sure that you’re getting what you need. If you decide this is not a good fit for you or you don’t want to continue therapy, no problem. Just let me know so that we can get you to the right place.” Not every therapist is the best fit for every client. I also encourage clients to let me know how I can tailor treatment to meet their needs. And if they start working with me and I’m doing a type of therapy they don’t like, or maybe they want to have more time to talk, or maybe they want more skills, hey, just tell me that. Every client is different in what they need.
So we went through several tips here on improving client retention. And I think this will really help your practice. And I’ll say real quickly again, educating clients on the process of therapy before and after the first appointment, making it as easy as possible for clients to get on your schedule for a first time and concurrent appointments, give specific, tangible recommendations at the end of the appointment, as far as what you’re going to be working on homework for them and how many sessions you’ll need to be working with them and getting them scheduled at a regular time. Offer financial problem solving help if they feel like they can’t afford sessions and wait on them to let you know that. Don’t just assume that or say that. That could be offensive or hurtful for them and they want to come and see you for treatment.
So be confident in that you can help them. And then make sure that you are giving them a good client experience, really listening and caring for them, right where they’re at. And I want you to follow up with your clients. If you don’t hear from them from awhile, check in and see how they’re doing to make sure that they got their needs met. So I look forward to hearing from you guys. Take some of these tips, start using them, send me an email, let me know how it’s going. I love hearing what your experience is like. I love hearing how the podcast is helping you in your practice. So shoot me an email after you do these, or just shoot me an email and say, “Hey Whitney, I’m going to use this tip on being more sensitive in the practice. I’m going to use this tip on making my appointments more available through online booking.” I’d love to hear from you and my email is email@example.com. I appreciate you taking the time to listen to this podcast. And I love helping you build your businesses. It’s my passion and I’m just honored that you let me do that for you.
Thank you for listening to the Faith in Practice podcast. If you love this podcast, please rate and review on iTunes or your favorite podcast player. If you liked this episode and want to know more, check out the Practice of the Practice website. Also there, you can learn more about me, options for working together, such as individual and in group consulting, or just shoot me an email, firstname.lastname@example.org. Would love to hear from you.
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