iCouch has been around since 2010 and needless to say, we’ve become experts in therapy appointments as well as how to get more therapy clients. We see patterns among our hundreds of practitioners that use our practice management software. We also frequently talk to our therapists and coaches to get a deeper insight into their businesses. We’ve noticed that there is not that much difference between client behavior with online therapists or in-person practitioners.

What that means is that getting online clients is just as hard (or easy) as getting new offline clients. Essentially the mode of delivery has little impact on client retention. However, the online mode of care delivery does have a distinct advantage over offline sessions in reducing repeatedly missed appointments. We’ve written before on ways to reduce missed appointments and online care delivery definitely helps. Things like text message appointment reminders help reduce missed appointments by 25% (for both online and offline therapy modalities.

The client-therapist life cycle

Initial Contact

The typical client-practitioner relationship begins with the initial contact. This is when a client finds you through a find a therapist directory, a web search or through a referral from their insurance or health care practitioner. Once the potential client decides to make contact with you, the ball is in your court to make it easy for that client to get the care they need and maintain that therapeutic relationship for as long as needed. How can you improve that initial contact experience in order to better retain that client and either keep them coming back or begin treatment in the first place?

  • Be prompt. When a potential client gets to courage to contact you with their concern, they want help right then and there. When you’re depressed, having an anxiety issue or going through a tough relationship issue, minutes seem like hours and hours seem like days. You may be very busy, but unless you are actually in the middle of a client session, you should drop everything to follow up with that lead. If it’s 10pm and you’re relaxing with a movie before bed, you should return any inquiry messages immediately. Don’t wait. Even if it’s just a short message to acknowledge their query. By responding immediately, this provides comfort to the potential client; they know you’re listening and they know that you care.
  • Be available. Using online scheduling (like what iCouch practitioners use for their booking calendar) provides a huge benefit to helping clients survive that initial contact phase of your therapeutic relationship. When they can make an appointment easily and quickly, they’ll be more likely to do so. An online schedule has the additional benefit of saving you a phone call! A potential client can book a session right away without having to wait for your business hours when you can answer the phone. Having availability (even if you just have one appointment slot open per day) can mean the difference between getting a new client and not. If you’re only available Tuesdays at 11am, then the odds are that time isn’t going to work. However, if you have a time slot available each day of the week (perhaps including the weekends,) then you’ve reduced the friction for that potential client to book with you. If you’re never available, you’ll never get new clients. Despite how good you think you are, there are tens of thousands of therapists competing your clients! If a potential client has to wait weeks for an appointment, you’re going to miss out!
  • Be low-stress. Some practitioners flood a new client with papers to fill out. When a new client has to fill out a 20 page intake form, a detailed medical history and all sort of other information, it creates a huge psychological barrier between you and them. When you call a friend on the phone for some advice, do you ask them to read over and fill out a dozen-page questionnaire? Of course not, you just get right to it. Obviously you can’t omit an informed consent form, but do you really need to ask them about their family tree six generations back? I understand that the more information you have that it makes your diagnostics easier, but why not defer some of that past the first session or possibly gather some of that information during the course of conversation during the first session? Don’t make your intake process intimidating or too “clinical.” During a first session it typically isn’t relevant that the client has a medication allergy or had a recent surgery. Ask those questions once they become required. Consider yourself on a need to know basis. Certainly you want to be comprehensive, but do it in a way that doesn’t feel like applying for a mortgage. Be creative and ask yourself what information is actually and unequivocally needed for a first session.

The Initial Contact is your chance to make a great first impression. It’s where you show that you care, that you’re easy to work with and that you can be trusted. It’s the place to demonstrate competence, confidence and personality. The smallest details here make the biggest impression.

The First Therapy Session

Once you actually get to meet your patient for the first time, either through HIPAA compliant video conferencing or over the phone, you have hopefully created a positive experience thus far. Much like a hotel lobby sets up the expectations for a guest, how you handle your initial contact ought to have set the stage for a great therapist-client relationship. During the first session, you’ll want to ensure you do the following:

  • Don’t be judgmental. This should go without saying however it’s very common that a therapist thinks they’re being “good” when in fact they are putting off an air of judgment or condemnation. A true professional knows the importance of being impartial, but we’re all human! Perhaps ask some of your existing clients with whom you have a good rapport to see what they think about your “bedside manner.” You might also consider having a fake session sometime with a friend and record a video of the session so you can examine your micro expressions and demeanor, especially when your friend tells you something shocking. Attempt to role play if you think your in-session manner could use some work. If you are finding that you aren’t having good luck with repeat bookings, then this is an area you might investigate. Practice does make perfect. Despite your advanced education and superior intellect, you aren’t perfect. One of the big reasons clients don’t return for follow up sessions is that they felt like they didn’t connect with their therapist. This is something you can improve! Just be honest with yourself and set your ego aside.
  • Leave unfinished business. This is an old writer’s trick, actually popularized by Ernest Hemingway. The idea is that you should never write until you’ve run out of things to say. You should stop just before. This way, the next day when you begin working, you start writing with that sentence you didn’t finish the day before. This “primes the pump” so that you can easily get back into the rhythm. With a therapy session, this strategy can help you keep your new client engaged with therapy. By saying things like “let’s continue this discussion in our next session,” you’ve built in a natural incentive to book the next session. Make sure you make a note of where you left off so you can jump back into the conversation at the next session. By not running overtime and providing an incentive/topic/therapist-marketinge to book the next session, your client will be very interested in keeping the next appointment.
  • Send a thank you email or text message. A few days after the session, send an email or a text message to your client with a simple, “I enjoyed meeting with you last Tuesday. I am looking forward to seeing you again tomorrow.” By increasing engagement, even in such a small way, you’re reminding your client that you are thinking about them. You also are presenting an image that you care about them (hopefully you actually do!) Your first session is vital. By doing some simple things like improving your bedside manner, managing your session to create an incentive for the next session and following up with a short reminder a few days later, you can make it easier for a client to keep coming back.

Ongoing treatment

If you get the initial contact and the first session “right,” maintaining a productive therapeutic relationship shouldn’t be too hard. However, don’t assume that just because you and your client are seemingly doing well together that they’ll keep coming back. Many clients are actually sacrificing quite a lot to come to their weekly appointments. They may not say it, but it’s definitely a hardship to travel to your office and pay money each week. If your sessions last 1 hour, then it’s potentially 2-3 hours of total time invested by your client if you add in the commute and waiting room time, not to mention any time spent scheduling the appointment, contacting you, etc. They may have to find child care, take time from work or miss an activity that they enjoy. Don’t take this for granted! Don’t assume you are the most important thing happening in their life. From a health standpoint, you very well may be, however you client isn’t going to perceive it that way. There are a few things you can do to facilitate maintaining the relationship.

  • Reduce appointment frequency. While you might think that having bi-weekly or monthly appointments will harm your finances compared to weekly appointments, in reality, weekly appointments can quickly become a hardship for many people, thus leading them to prematurely end treatment. Unless their condition is such that it requires closer observation, consider your client before assuming that weekly appointments are necessary. This will have a paradoxical benefit to you. Since seeing you requires less inconvenience, they’re less likely to miss their appointments, while a weekly appointment means more money for you in the short term, over the long term they’ll be far more likely to start missing appointments. Obviously their treatment is priority. Never, ever schedule or not schedule appointments because of some kind of financial motive. That is unethical and just trashy. However, do be aware of your client’s finances and time. If you can make it easier on them, please do! They’ll thank you by continuing their treatment and missing fewer appointments.
  • Use online therapy. I hope we’re past the point where some practitioners still have reservations about online counseling and therapy. The “Is online therapy effective” question has been answered in the scientific literature time and time again. Of course there are certain situations for which online counseling would be counterindicated, but the vast majority of patients could benefit from online therapy. If you aren’t completely sold on it, that’s perfectly fine, you can augment your in person sessions with online sessions. Perhaps every other session could be online. This is going to make it much easier for your clients to stick with your treatment program. Over time, you might then transition your client to only online therapy sessions when their treatment progresses to a maintenance mode.
  • Keep your clients engaged. If you’re a Cognitive Behavioral Therapy practitioner, the iCouch CBT iOS app could be a good tool. You could also use paper or any number of mental health mobile apps out there. By employing appropriate apps and technology and interesting and engaging “homework” for your clients, you keep them more invested and involved in their treatment process. The more engaged your client, the more likely they are going to benefit from your services. Following up It’s natural that in the course of treatment some of your patients will no longer book appointments or need your services. If you were to periodically check in with them, perhaps sending an occasional email, they’ll be more likely to remember you and potentially recommend you to their friends. If you’re following our Therapist Marketing suggestions, you should also get your former clients to subscribe to your blog and your business social accounts. By keeping them engaged over the long term, even if they aren’t actively booking your services, if they’re engaged with your content, they’ll be a lifelong customer and they’ll also help you build an audience when they share your remarkable blog and social content. Don’t think that just because they aren’t booking sessions anymore that they aren’t still important! If you are good at what you do and you care about your clients, they will be back!

Published by Brian Dear

Brian is the cofounder and CEO of iCouch, Inc. He has an extensive background in software engineering, inbound marketing and mental health practice management.

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