As professional counselors, we help others. It’s in our DNA, our personalities, and our extensive training. This is usually a good thing. However, it has its dark side too. Over the last 10 years, I have noticed an alarming reluctance among counselors to run their practices so that they benefit their clients AND manage to keep themselves in business. It’s as if counselors have the motto: “If it’s good for me, it’s probably bad for my clients—and it’s also probably unethical.”
For example, I have consulted with counselors who have tens of thousands of dollars in uncollected fees, because they can’t bring themselves to ask their clients for the money they owe. I’ve heard providers say, “I’m their counselor. It’s uncomfortable to take money from someone I’m supposed to be helping.” Some counselors even try to make a case that taking money from clients hurts their treatment (we’ll address this in a future article).
Secondly, I have been meeting with counselors who have poor client retention. According to their caseloads, it seems to them that clients today are staying in treatment for shorter and shorter durations of time, and attending sessions less consistently than ever before. Forget the brief therapy model of 12 sessions—some of their clients average as little as 7 sessions or less (surprisingly, those clients are often not made aware that an ultra-short stint in therapy doesn’t mean they’re “all better,” and isn’t recommended by even the briefest therapy models).
Client retention is an ethical issue. But for the vast majority, the issue is not about the ethics of manipulating clients to stay in treatment (which is what some counselors think “client retention” is); rather it’s becoming an ethical issue around not providing adequate and complete treatment to clients.
If you think you and your clients could benefit from more sessions together, here are 7 ethical strategies for improving client retention:
1) Familiarize Clients to a Suitable Course of Treatment
Counselors need to educate clients about what constitutes a typical course of treatment. Consider this:
A few years ago, I was having some neck and shoulder pain, so I paid a visit to a local chiropractor. During my first consultation, even before my first chiro-adjustment, my chiropractor asked me how often I planned on coming in. I answered that I was thinking I would come in once a week.
She responded, “Well, I won’t turn you away if you want to come in just once a week. However, you’re not going to see the benefits you’re hoping for unless you come in at least 2 or even 3 times a week, for at least the first couple of months. I will probably need to readjust your back every few days, to make any lasting improvements.”
I appreciated the information. Had I been left to my own devices, I would have wrongly assumed that once a week would be enough. We agreed on two sessions a week for the first 6 weeks, and scheduled a re-evaluation appointment for 6 weeks later.
Unfortunately, when it comes to educating therapy clients about a recommended frequency or duration of treatment, counselors often resist—because they are wary of manipulating or strong-arming clients (a potentially needless worry, since, in actuality we rarely have that much influence!).
Wacky Counselor Statements:
“I let new clients decide how often they come in, and I try not to influence their decision.”
“I think clients know how often they need to see me.”
“It’s unethical to tell clients how often I think they should see me for therapy.”
2) Familiarize Clients to a Suitable Course of Treatment—AGAIN
My orientation to chiropractic medicine didn’t end at the beginning of my first session.
After my first session, I was given a bag of goodies ranging from coupons for chiropractic products to a local massage therapist, to samples of a therapeutic sports cream. Also in the bag was a small book titled “Chicken Soup for the Chiropractic Soul.”
The book contained a number of stories about people with back pain or posture issues, who sought chiropractic help for their ailments. The stories illustrated—in inspirational detail—how, after many sessions, patients’ backs became straighter, stronger, and healthier, and how their pain went away.
In retrospect, I am sure that the stories from this book encouraged me to stay in treatment on days when I wasn’t feeling particularly motivated.
Wacky Counselor Statements:
“During the first appointment, I try to convince the clients not to come back.”
“The problem is that clients are ambivalent about whether or not they want to be in counseling.”
“If clients don’t continue treatment, they must not be ready to change.”
3) Familiarize Clients to a Suitable Course of Treatment—AGAIN, and AGAIN, and AGAIN…
As my chiropractic treatment progressed, one thing I noticed was that my chiropractor actively encouraged me to continue treatment, and noted my progress regularly (which served as encouragement to continue). When I sat in the waiting room (usually for only a couple minutes—therapists take note), I would look up at a framed print on the wall. It read, “Every session builds on the last” and contained an image of a bricklayer, hardhat and all, building a brick wall, one brick at a time. I laughed a couple times at the cliché, but I also got the message.
The Message: Every appointment was getting me incrementally—sometimes recognizably so and sometimes less recognizably—toward my goal.
I tell this story to counselors, and they cringe. “The doctor actively encouraged you to continue treatment? Didn’t you feel taken advantage of? Didn’t you feel like a meal ticket?”
My answer has been and will continue to be “Not at all!” In contrast, I felt that I was getting excellent service and a high quality of care. Sure, the doctor was making money from my sessions, but I was getting what I came for—a positive treatment outcome.
Important Note: For me, arguably a pretty motivated patient, a positive outcome necessitated not just great chiropractic care, but also regular encouragement to keep me coming back for more care and continued care. Might counseling clients need such encouragement too?
Wacky Counselor Statements:
“A good number of clients can be finished with counseling after 5 or 6 sessions.”
“The client I saw today only needed 1 session.”
To Be Continued…
Yes, this article promised 7 strategies for improving client retention. We have 4 left to go!
Anthony Centore is a counselor, and helps other counselors build successful practices. For more information on private practice and insurance panels go to http://thriveworks.com .