How to retain more of your therapy clients for longer

How to stop your clients from quitting therapy prematurely

Are your clients leaving? It’s inevitable, but that fact doesn’t make it any easier. The problem isn’t that your clients are leaving at the end of a treatment plan, but that they’re leaving prematurely and often without notice.

When a client leaves abruptly, it’s not only unsettling, it’s one of the most difficult situations you’ll face as a private practitioner. You’ll wring your hands and wonder what you did wrong. You’ll retrace your steps and analyze your last session to look for clues you may have missed. It’s torturous, to say the least.

Sometimes, there’s nothing you can do to prevent your therapy clients from leaving. A study published in the Journal of Consulting and Clinical Psychology found that in the U.S., the drop out rate is between 40% to 60%. What’s even more troubling is that the overwhelming majority of those who drop out do so after just two sessions.

However, there may be something you can do to improve your client retention rates. Let’s dive into the most common reasons why your clients may leave prematurely, and what you can do to prevent it from happening.

“The client drop out rate is between 40% to 60%, with the overwhelming majority dropping out after just two session”

Journal of Consulting and Clinical Psychology

First things first

Avoid the temptation to blame yourself. It may be a natural inclination but, as mentioned earlier, client attrition is a problem that all private practitioners have in common. No matter what you do, you will lose some clients prematurely. The goal is to do everything you can to retain as many clients as possible. Instead of assigning fault, it’s best to focus on solutions. Let’s discuss.

Common reasons why therapy clients stop showing up

What are the top reasons why clients leave therapy before the end of treatment? Let’s look at the 11 most common risk factors that indicate probable client attrition and what you can do about it.

1. Client has a specific disorder

The type of disorder that you’re treating can also affect the client’s willingness to stay around for the duration of treatment.

Clients with personality or eating disorders are the likeliest candidates to discontinue psychiatric care. One study showed that those suffering from personality disorders were 51% more likely to discontinue treatment. Researchers are still unsure of the reason why this happens.

What can you do about it?

If you specialize in this area, there’s not much you can do. Simply acknowledge that your niche is more prone to client attrition, and help the ones who are completely invested in their treatment.

2. The client is in a specific demographic

Your client demographics can impact client retention. For example, a client’s socioeconomic status can influence their decision to drop out of treatment. Poorer patients are less likely to continue treatment. Also, age makes a difference. Those in their 20s are less likely to continue therapy than older clients.

What can you do about it?

Same as above. If you specialize with this demographic, it’s important to note that treatment may be disrupted.

3. Administrative problems

Sometimes, clients miss or cancel appointments because of administrative problems on your end. From not seeing clients on time to providing unsatisfactory customer service, poor administration can negatively affect your reputation. You must present a professional face for your private practice in order to retain your therapy clients. Otherwise, they’ll lose trust in your abilities and start seeking help elsewhere.

What can you do about it?

Always look for ways to improve your administration. Whether you’re working by yourself or with a team, you can tweak systems to create a smooth and satisfying experience for your clients. Start streamlining your practice with our management software. Use Ensora Mental Health for therapy notes, invoicing, scheduling, and sending out reminders via email, text, or voicemail. Get started with your free 21-day trial here.

4. The client is afraid

Some clients simply don’t like getting in touch with their emotions. They may start off with the idea that they’re ready to face the truth, but when it’s time, they start to hesitate.

What can you do about it?

Have an honest conversation with your clients about what to expect during this process. This talk can prepare them for the thoughts and emotions that surface over the course of treatment. Your client needs to understand that what they may encounter is part of the process.

5. Your office is uninviting

This may sound shocking, but your office can play a role in client retention. Offices that are poorly decorated or bland can make clients feel like treatment will be substandard. This is known as the halo effect.

What can you do about it?

It may be time to decorate your office space or move to a new space altogether. If you need help, here are some tips on how to decorate your private practice.

6. Insurance doesn’t pay

Some insurance companies don’t cover mental health treatment. A client may seek out assistance for a known issue, but realize that the financial burden is too great to continue treatment.

What can you do about it?

Unfortunately, when clients pay out of pocket, they may be more likely to end treatment abruptly. Ironically, one of the best remedies for this may be to convert your practice to self-pay only. This way, you can better control prices, and offer discounts to clients who cannot pay the normal rate. Flexible payment options might also help.

7. The client has unrealistic expectations

Blame Hollywood. Blame faulty advice from well-meaning friends and family. Blame the Internet. Sometimes, clients come to your practice with unrealistic expectations of how treatment works. They may become overwhelmed when a lifetime problem doesn’t resolve within a month of meetings.

What can you do about it?

Give your clients an end goal for each treatment, whether that’s a few weeks or a few months into the future. Knowing the end date can often motivate clients to continue with their course of treatment.

8. Therapy is too inconvenient

Most clients have a lot of responsibilities such as a full-time job, a family with young children, and a social calendar. Although they may recognize therapy is important, it can be eclipsed by other pressing needs. What happens if an unreliable babysitter cancels? Or if the client has a hard time reaching your office across town due to traffic? Sometimes, inconveniences can lead to attrition.

What can you do about it?

Find ways to convenience the client. Perhaps offer extended or weekend hours to avoid rush hour traffic. You may also offer sitter services in your office if you cater to a lot of single parents who may not be able to find help elsewhere. Make a list of the problems that may be affecting your particular clientele and find solutions that minimize their need to cancel a session.

9. You’re inexperienced

Some clients simply drop out because they don’t trust your level of experience. Perhaps you’re just starting out or you’re new to private practice. You can expect drop out rates of up to 75%. Ouch. But the good news is that you’re not alone. Most new clinicians have to face this dismal retention rate.

What can you do about it?

Be grateful for the clients who are willing to stick with you. Continue to work with them diligently, and ask for referrals. 

10. The client doesn’t understand the need for ongoing help

After a session or two, your client may feel like they have a handle on the problem. The symptoms have started to recede, and they feel better. Premature termination will backfire, however, since the client may not realize that the full course of treatment is necessary.

What can you do about it?

After you’ve set a treatment plan, have an honest conversation with your client about why it’s important to stay the course. Discuss what may happen if they leave prematurely. Explain your role and the client’s role. Be open to questions.

11. The client reaches the end of treatment

Your client has finally reached the end of their treatment. Hooray! However, you may still be able to keep the client around for longer. Often, successful treatment leads to new areas of discovery. For example, a client may find that they’ll benefit from a family therapy session.

What can you do about it?

Encourage your clients to explore the different services that you provide, as long as you think that it will help them.

Final thoughts

When you give your best to helping your clients, it can be demoralizing when they stop coming. Just remember that you’re not alone. Every therapist must face this same exact conundrum. However, by using the above tips, you will improve your client retention rates.