5 Tips to Increase Client Retention
If you’re a Couples Therapist in the first years of practice you know how hard it is to keep couples coming to sessions long enough to actually help them. Once you’ve been at it awhile you figure it out but until you do, seeing them infrequently and being “ghosted” is pretty hard to take. It can be tempting to “go along with” clients requests or to avoid “rocking the boat” as you’re getting to know each other. Then when you start being more directive and they don’t book another session you realize an “unspoken rule” has unintentionally been established. This crushes your confidence and might add another experience of “couples therapy didn’t work” to the story the couples tell themselves.
There is a better way!
I’ve prepared 5 Tips to Increase Client Retention to help you establish a more effective way to start the your therapeutic relationship with couples. These suggestions will help you set yourself and your clients up for success from the start and may even restore your confidence as a couples therapist.
→ TIP 1: Have a checklist/system to decide if you will offer service.
While you may feel pressure to work with everyone that books a session, you must be mindful about who you offer couples therapy to. I understand you need to see couples to improve your clinical skills and that your income is dependent on it; however, you also need to work within your scope of practice and do work that is effective. This practice will increase your client retention rates as well chosen clients usually attend sessions as planned.
Couples often wait too long to start therapy and have patterns of behaviours that keep them stuck in a cycle that makes resolving their issues difficult. They don’t know how couples therapy works and may be skeptical that it will. Remember, they’re with you because they know they need external help BUT they don’t feel good about it and they really “need it to work”.
Whether they say it or not, couples are relieved when you tell them how couples therapy works, what you will do with them and what you expect them to do if you agree to work together. Giving them a plan and following makes something predictable in a challenging time. It can be grounding for them and may even give them a glimmer of hope or relief that allows them to feel less anxious about being with you and about couples therapy in general.
In order to do this, you need to develop a structured way of working with them that you’ll explain in the first session. It should include the number, duration and frequency of sessions and how often you will do review sessions. As well as what your expectations for booking and session payment, clients commitment to the process, rescheduling and canceling sessions and ending couples therapy. In addition to your checklist or way of determining if you will offer service or not.
These preparations not only ensure you are working within your scope of practice but they also create a therapeutic container that organizes the work, improves client retention rates and sets you and your clients up for successful therapy outcomes. A session that helps a couple understand why they haven’t been able to resolve their issues on their own IS helpful – even if you are not able to work with them right now.
→ 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
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 can restore your confidence and will improve your retention rates as you continue to develop your skills and become a Confident Couples Therapist.
For More information visit the Confident Couples Therapist Workshop Website