Increase Client Retention: Helpful Tips for Couple Therapists
If you are a Therapist who works with couples you know how hard it is to get them to come to sessions regularly and to attend long enough to actually help them. Maybe you follow their lead, keeping them happy while you’re getting to know them, but when you need to be more directive – and make no mistake as a couple therapist you definitely need to be directive – it can feel like you’re being mean, like you’re breaking the rules and they won’t come back. However, the best way to get them to come back (and improve your retention rates) is to prioritize being helpful over being likeable.
Couple therapy is a relationship improvement journey and you are the driver! A helpful driver gets couples to a better place in their relationship regardless of the pressure from the partners to go around the loop again and again. When you take your place in the driver’s seat – by being as gentle as possible AND as firm as necessary – couples are happy to engage in the couple therapy journey with you.
Couples come to you for help when their efforts to get to a better place don’t get them there. They ask for help when they’re stuck, have been stuck – sometimes for years – before being willing to explore couple therapy as an option. And when they finally do – after saying they were going to many times before but didn’t – experiencing you as helpful matters more to them than you being likeable does. Couples attend sessions regularly when they believe their driver can get them to a better place – the place they have not been able to get to on their own.
Being more directive is one of the most challenging differences between individual and couple therapy. It is also a significant piece of the client retention puzzle. In couple therapy specific supervision with me you will think of couple therapy as a relationship improvement journey and you will be supported in taking your place in the driver’s seat. When you prioritize being helpful your retention rates will improve and not only will you be likeable – you will also be referable. Are you ready to get started?
Helpful Tips!
→ TIP 1: Use an assessment protocol to determine if it is appropriate to engage in couple therapy.
While you may feel pressure to work with every couple that books a session, when you prioritize being helpful you use an assessment protocol to determine if it is appropriate to engage in couple therapy based on the presenting problem, client factors, therapist factors and risk factors. It’s true that you need to see couples to improve your clinical skills and your income is dependent on it; however, you also have to work within your scope of practice and do work that is actually helpful.
PREPARATION = RELIEF FOR COUPLES: When you confirm the first session explain what you do in the first session. Tell them you won’t be “fixing” anything in this session but rather understanding what is happening between them so you can determine if you can work with them at this time. Tell them when you will let them know if you can help them or not. For example, if you do a four session assessment protocol explain that to them in the confirmation email so they know how many sessions they will attend before that decision is made. Knowing what to expect from you in session is helpful for couples.
→ TIP 2: Do Review Sessions Regularly
This important but often overlooked practice is done to identify and celebrate progress, discuss challenges, review expectations and revise goals. It helps to keep clients engaged long enough to face their problems, increase distress tolerance, make progress and ideally have a successful therapy outcome. It’s an opportunity for each partner to talk about how therapy is going for them and allows the therapist to demonstrate an effective conflict resolution process with them.
To this end, I recommend you encourage clients to identify something they don’t like about your work together to process in the review sessions. In response, you model vulnerability and are receptive while hearing them and responding to a complaint or criticism in the same way YOU EXPECT them to do with each other. It’s also a way to ensure that what you are expecting your clients to do is realistic and possible. Regular review sessions increase client retention as they catch issues that might otherwise go unnoticed and allow you to work through them together.
→ TIP 3: Use a Session Plan to Stay Focused and Avoid Detours
Write the goal you’re currently focusing on at the top of your session plan and add anything you’re paying attention to, along with what you plan to do when you see it. As well as anything you need to follow up on with the couple, as noted after the last session. For Example:
Goal: Improve ability to recognize disconnection and restore connection
NOTICE:
1. When he turns away from her, if she notices and how she responds to it.
2. Notice when she looks to me for validation, if he notices, how he responds.
HOW I WILL RESPOND: I will interrupt – by learning forward and holding up my hand while saying, “Wait, wait, just a second now. Jim you just turned away from Sarah, what were you feeling before you did that OR what made you do that? OR I WILL SAY: “Wait, wait I need a second here. Sarah it looks like you’re feeling something you want me to know about. Could you tell me what it is?” Then use what you learned from their answers and proceed with what you have planned for the session.
Be sure to summarize progress and celebrate wins with clients, especially when the “problem” isn’t resolved yet. Remember, when you get sidetracked, LOOK at your goal (that’s why it’s important to have it in front of you) and INTERRUPT them like in the example above, REMIND them of the goal you all agreed to work on and FOLLOW your PLAN for the session.
→ TIP 4: Identify what Side Tracks you and Plan Your Response
This probably requires you to be more directive with your clients. For example: “problem of the week” discussions that set up a boxing match like “what happened with the last therapist”. YOUR PLAN: You won’t ask “how was your week?” to start the session. Instead you will pick up where you left off last time by asking how they did with that thing they agreed to do last session. When needed, you will redirect them by reminding them of the progress they’ve been making (or said they wanted to make) in changing this pattern.
For example: Using body language you plan to interrupt them and say something like, “Hey Sarah, I can see this is really bothering you. Remember what happens to the connection between you and Jim when you raise an issue this way? (alternating looking at each of them while talking to her) You’ve both been learning how to stay connected while talking about issues, and you’ve been doing a good job of not blaming each other. We’re going to work on that more today, so let’s pause this for now okay?”
Make sure you also have a plan for what you’ll do if you need to be more firm. You have to show them that you CAN and WILL interrupt the patterns that they have done in couples therapy – with at least two therapists. Remember, if they knew how to do this differently they would. That’s what they need you for. You can tell them this to soften the redirection if you think it will help.
By staying focused and planning what you’ll do when you get side tracked in this way, you are more likely to help the couples you work with. As things start to change for couples and their confidence in “couples therapy working” increases they become more committed to the process, thereby increasing your retention rates.
→ TIP 5: Be as Gentle as Possible and as Firm as Necessary
Getting familiar with and comfortable in your role as a couples therapist takes time, dedication and determination. It’s a process of experiential “learning while doing” in which you only get better at “doing it” by “doing it.” It is uncomfortable for sure! Couples therapists have the added challenges of managing the dynamics between the couple and the need to have a strong and balanced alliance with both partners. In order to do this the couples therapist needs to be directive and in charge of the room as a compassionate leader – even when doing so doesn’t come naturally or easily.
Couples often show up in therapy after facing the hard truth that they can’t fix their problems on their own and they need a therapist’s help. Many are skeptical and wonder how a therapist that doesn’t know them and their unresolvable problems can possibly help them. I encourage you to think of yourself in the same situation. The empathy you feel for them may cause you to be too gentle when what gives couples a sense of hope is your ability to be empathic while also being in charge. Being directive like this IS NOT harsh, mean or rude, even when you are being more firm than gentle provided you do it with empathy and compassion.
The good news is that while you’re “finding your way” and learning to be more directive you can rely on the mantra “as gentle as possible and as firm as necessary”. It takes self awareness and practice to develop the ability to do this “on the fly” but you have the ample opportunity to practice it in your work with couples. You can also review your progress in supervision or with your colleagues.
Over the years I have learned that couples (myself included) go to therapy when the pain of staying the same is worse than the pain of changing. Couples need your help. They don’t know how to change how they’re being with each other without it. When they FINALLY get themselves to a couples therapy session, they need you to be in charge in order for them to believe you know what your doing. While it may feel counterintuitive to “be in charge” remember you don’t have to be harsh or overly firm with them. You only need to be “as firm as necessary” with them and see what happens – for them and for you. You’ve GOT THIS!
These 5 Tips to Increase Client Retention will help you build your confidence and improve your retention rates as you continue to develop your skills and “way of being” as a Confident Couples Therapist.
