One of the main things I teach my students in my Professional Readiness and Ethics classes is the concept of client retention. Here are some points that I feel are critical:
• Admit clients when they are in crisis. Job loss, eviction, arrest, domestic dispute, illness, injury, financial trouble, and other crises tend to motivate clients to enter and stay in treatment.
• Develop referral sources that have contact with clients in crisis—employers, police, lawyers, probation officers, social services, domestic violence shelters, mental health centers, medical clinics, and churches.
• Reduce waiting times and expedite intake. Schedule first appointments the same day the client contacts you or the next day if possible. At the very least, provide telephone or drop-in support while they wait.
• Promote innovative and flexible approaches that seek to expand the variety of clients eligible for your services rather than retaining stringent admission criteria. For example, rather than excluding clients with co-occurring disorders, modify your program so that you can treat dual diagnosis clients in an integrated fashion.
• De-emphasize the “medical”, “pathological”, “disease” appearance or approach to treatment. While professionalism and reimbursement of services is very important, it is equally important to exhibit a welcoming atmosphere that builds rapport and reduces stigma.
• Provide evening as well as day-time appointments, individual sessions as well as group and family sessions.
• Provide individualized treatment planning as indicated by unique treatment goals, methods, modalities, intensity and duration of treatment.
• Develop group sessions that cover “real life” topics, everyday skills such as assertiveness, discipline techniques for parents, self-esteem building exercises, money management, problem-solving/decision-making skills, etc.
• Increase family/significant other involvement in treatment. A parent (usually the mother) or a female relative is usually the best support person. Include at least two sessions with significant others.
• Take a “first things first” approach by:
o Allowing clients to talk about immediate concerns or areas of competence and success
o Showing clients how their immediate concerns and plans can be resolved and achieved by staying in treatment
o Asking open-ended questions and seeking the client’s honest reaction to being in counseling
o Being a good listener and seeking first to understand (then, and only then, to be understood)
• Structure the first few individual counseling sessions with the primary goal of developing a relationship of mutual trust and respect, with motivation to comply with treatment as a secondary goal; discuss how the client feels about being in counseling (embarrassed, ashamed, anxious, proud, stigmatized, etc.)
• Develop mutual trust and respect with clients by earning it; set limits respectfully; be considerate; make them want to come back; identify with them as a person and a professional
• Be empathic and nonjudgmental while demonstrating unconditional acceptance; use confrontation while observing cultural sensitivity and diversity
• Maintain a hopeful, positive, solution-oriented, “can-do” attitude toward clients instead of a “we’ll get ’em when they’ve hit rock bottom” approach. Convey this empowering stance to clients by encouraging them and noticing even the smallest changes
• Identify the clients’ low income, minority status, lack of education/ability, family obligations, and other obstacles associated with treatment dropout; adjust your approach accordingly
• Since effective counseling for different cultural groups is more closely related to shared attitudes and values and is less about shared ethnicity, develop an awareness and understanding of the values of different ethnic groups and non-judgmentally incorporate these values into treatment.
• Be attentive and remember details; be trustworthy and dependable; don’t be pretentious or try to impress with big words or “psycho-babble”
• Ask clients for honest feedback at the end of each session; for example, ask, “On a scale of one to ten with one being ‘useless’ and 10 being ‘very helpful’, how was this session for you?”
• When a client misses an appointment without notice, immediately call or email the client and be persistent until they either return for services or withdraw; if the client does withdraw, ask why and document and document reasons for program evaluation purposes
• If a client attending group has a slip or relapse, don’t terminate their treatment; schedule individual sessions to address relapse prevention; then have the client return to group
• And, finally, be a “salesperson”; find out exactly what each client wants and what steps they could take to get what they want; then, sell them on the idea that they can get what they want by achieving their treatment goals (which incorporate these desired outcomes).
Barbara Jordan is a counselor, counselor educator, author, trainer, and leadership coach. For more information go to www.AdvantEdgeSuccessCoaching.com.