Building a consistent client base for your mental health practice

Welcome to the "What to Know Before Opening a Mental Health Practice" series by Kristin Trick, MA, LPC-S, RPT. Drawing from a decade of diverse clinical experience spanning psychiatric hospitals, nonprofit agencies, and private practice, Trick shares the top 5 lessons she wishes she had known before becoming a solo practitioner. Packed with practical advice and insights from her journey, this series supports mental health professionals looking to establish a thriving and sustainable practice.

One of the toughest matters to consider before opening a private practice is whether or not you can maintain a solid caseload. A full schedule of clients ensures steady profits and is critical to the continuation of any counseling business.

Initially, I felt nervous confronting this issue because the responsibility for bringing in clients had been managed by other people at my previous worksites. I had regularly seen intakes listed on my calendar but had not put in the work needed to earn those first sessions. 

Before committing to my own practice, I sought advice from colleagues and other professionals about how to attract and retain clients. The knowledge I gained has enabled my practice to remain operational where it otherwise may have fizzled out, and I’ll share it here.  

One of the best pieces of wisdom gleaned during my preparatory research had to do with specializations. In the preliminary visions of my practice, I had naively planned to inform all callers that I worked with every age and treated a wide range of symptoms. While these comments were true, they were equally vague and unhelpful since they did not distinguish me as a provider.

Contrary to initial assumptions, it is better to specialize in working with certain populations or presenting problems. An emphasis in either area will make your services desirable to potential clients as they recognize you as an expert. 

Since all counselors are unique with their own blend of skills, these strengths must be emphasized to prospective clients to help set your practice apart from others. Your services' exclusiveness can also guarantee a continual waitlist as clients choose to wait for you rather than go elsewhere for treatment.   

If you earned a designation as a Licensed Chemical Dependency Counselor (LCDC), mention that distinction during your conversation. If you were previously employed at a school, whether as a teacher or guidance counselor, incorporate this work experience into your dialogue. These personalized comments will help you paint a clearer picture of yourself as a counselor; prospective clientele will be more inclined to choose your services over an obscure and generalized sales pitch.

Specializations help you create a close professional network as you connect with similar-minded providers. Perhaps you live in a community with a shortage of counselors for children and adolescents. If you specialize in treating this population, you can establish familiar working relationships with local pediatricians and school personnel. These professionals will undoubtedly keep your practice in mind to share with parents as a referral.  

Likewise, a centralized focus for your practice can generate an overall positive impression for clients. Since you will be well-versed regarding their symptoms, treatment plans, and appropriate interventions, clients can feel more confident about your ability to help them.

Your assuredness about certain disorders or treatments can put new clients at ease and result in their personal referrals to friends, family, and coworkers. Especially if you are opening a practice in an area that is already peppered with counselors, these word-of-mouth referrals can produce a continuous stream of business.

There are many opportunities for counselors to earn specializations; they depend largely on your interests, available time, and finances. Since Continuing Education Units (CEUs) are required to maintain licensure, seriously consider what services you want your practice to be known for and complete relevant CEUs. 

Examples of counseling specializations include Applied Behavior Analysis (ABA) to assist with autism, Eye Movement Desensitization and Reprocessing (EMDR) to reduce posttraumatic stress symptoms, and a Registered Play Therapist (RPT) credential to focus on children and adolescents.

Yet another tremendous perk of specializations is the ability to choose which population you want to work with while ensuring that your work schedule accommodates your personal needs. For example, you may just be starting a family and have young children at home, which precludes you from meeting clients during normal daytime hours. You may only be able to schedule clients after school hours or throughout the evening (4pm-8pm), which just so happens to be the most coveted appointment time frame for working adults and parents. If you have specialized training in treating school-aged children, coupled with afternoon and evening availability, it is probable that you will have a regularly booked schedule.

Before opening your practice, evaluate the deficits in your community’s current mental health resources. Then, decide what you can offer clients that is difficult or impossible for them to receive elsewhere in your locale. 

Maybe you live in an area where counselors for toddlers are scarce or where substance abuse services are unavailable. Perhaps you have noticed an influx of Spanish speakers in your town, and you happen to be bilingual. Wherever you see a gap, hone in to assess how your practice can fill it.

Personally, I noticed a shortage of Christian counselors in my city and chose to emphasize a faith-based approach at my practice. Many clients who contact me about intakes share that they chose my business specifically because they wanted Christian treatment interventions. 

Similarly, I chose to become an RPT after hearing multiple parents’ and teachers’ complaints that there was a limited number of community counselors who would work with children. To this day, a large percentage of the business calls I receive are due to my RPT designation.

When building your caseload, keep in mind that you are planning for the long game. Too often, I have celebrated the scheduling of an intake appointment only to find that the client never returns for a follow-up session. Your new practice may be flooded with intake calls; however, if those clients do not keep their initial appointment or stop treatment after the first session, you are back to square one. 

Remember that counseling is a relationship that begins the moment you establish contact with a client. Rather than simply trying to fill your available hours, make your communication with clients impactful and forward-focused.

To create an exceptional practice, you must also be willing to initiate difficult conversations with clients. Though it is uncomfortable to talk about late-cancellation or no-show fees, tardiness for sessions, or declined credit card payments, these topics need to be addressed with your clients so they recognize the importance of your time and their treatment. 

The inclusion and maintenance of solid boundaries within your practice will generate respect for your services. Your clients will not view therapy as just another appointment but, instead, a commitment in which they have a deep investment. 

Follow these tips and best practices for client retention.

Whether you are making a phone call, writing an email, or sending a text, interact warmly with your clients. Thank them for letting you know in advance when they need to cancel their sessions; express genuine concern if they share difficulties about making payments; and remember their work and school hours when scheduling their appointments. A personal approach to their treatment, especially when it is shown outside of the clinical hour, will help your clients feel valued and respected.

Having resources on hand shows your clients that you have thoughtfully prepared for their sessions. Show them you are ready to take the lead instead of expecting them to steer all your conversations. 

In addition to helping you introduce new topics and demonstrate coping skills during sessions, resources can also be assigned as homework for your clients to return at their next appointment. Assessments, worksheets, and articles are useful for adult clients; stress balls, paper with markers, and clay are better received by children and adolescents.

Consider your ability to work at nontraditional times to accommodate your clients’ schedules. Could you open several hours on a Saturday twice a month? Could you see clients remotely from your home during the evenings? Your willingness to provide sessions outside of normal office hours can make your practice unrivaled for clients who cannot miss work or school.

Since counselors are not selling products, it can feel awkward to ask clients how they feel about their treatment. Nevertheless, regular updates from clients about what they are enjoying or disliking allow us time for modifications. Do not wait until it is time for a formal treatment plan update; incorporate questions into your weekly appointments and adjust your services accordingly.

If your practice hinges on one solitary treatment, you will lose business if your clients cannot adapt to it. For instance, if you are only trained in Cognitive Behavioral Therapy (CBT), your clients who struggle with this heavily analytical intervention can be expected to end their services prematurely. To minimize the risk of losing clients, ensure that you have multiple treatment types to offer and make rotations as needed. 

While working with an adult client who had complex trauma, I alternated our weekly sessions between EMDR and sand tray therapy. Our transition allowed the client to create visual depictions of their traumatic memories, which eradicated their mental blocking during EMDR sessions.

The grim reality is that many of our clients do not think positively of themselves, nor do they regularly hear supportive words from those around them. As counselors, we can encourage our clients during their most vulnerable hours. Communicate gratitude to your clients by thanking them for keeping their appointments or complimenting their progress.

Clients who feel that they are just a dot on our schedules will not return for treatment. Similarly, clients who think we do not remember what they shared during their last session will fade out of our caseloads. 

To avoid these effects, keep detailed medical records and skim through them before meeting with your clients. This approach helps you to move from one session to the next smoothly and shows your clients that you remember what is important to them.

Record potential clients' names, numbers, and insurance plans in a secure database. Though you may not have immediate room to schedule them, an opening can quickly appear. One of your current clients may announce they are planning a move or switching insurance companies, or they may delay setting a follow-up appointment. Hang onto the information given to you by prospective clientele so you can promptly contact them about an intake.

Your chance to build a strong foundation of clients begins the second you connect with a potential client. Be thoughtful with how you present yourself to those inquiring about your practice. This presentation sets the tone for future work together, including the intricate task of setting good client boundaries.