There are many factors that contributing to client retention. Many of the most powerful are not related to anything the therapist can do or not do. I am referring to things like:
–Client ambivalence about engaging in therapy
–Whether the customer for therapy is the client. (Sometimes a client is not very invested in therapy. Someone else, e.g., a spouse or parent, wants the change. The client in the room is not the customer.)
–The financial cost to the client. Cost influences his/her evaluation of value, undoubtedly affecting motivation
–Sometimes clients’ lives change in unanticipated ways. Some common ones: job change, health issues, family crises, etc..
–Previous experiences with therapy can influence current expectations and motivations
–Sometimes participants do not have the same goals for therapy. And without agreement, therapeutic success is unlikely.
–Current client expectations are not very reasonable, flexible, or malleable.
–Obstacles encountered trying to set up therapy. Forms not in the client’s language; inability to get an appointment when the client can come; how the intake process goes.
The existence of any of these presents a challenge. More than one and therapy is likely to end prematurely.
Additional things we ruled out
And additionally when we dug deeper into the client retention numbers we noticed variability from one therapist to the next. So what did that variability mean? Was it just random? When looking carefully at the numbers, randomness did not seem to account for all of the differences.
Could the variability have to do with caseload differences? This seemed at least somewhat true. For example, therapists with larger caseloads of children or teenagers had lower retention. Why? Perhaps it is more likely that they have more non-customer clients; those who feel forced to come to therapy. And yet there was variability even among those with similar types of caseloads. So not all can be explained by caseload differences.
In general, the longer someone is with us, the better their client retention numbers. This makes sense in many ways. For example, as we remain in one place, the clients who fit with us take up a greater proportion of our caseloads. And returning clients are already used to our style and again will take a bigger percentage of our caseloads. The mystery was why some “longer-timers” did not have higher client retention numbers and some who had only been with us two or three years had good client retention.
While therapists may be relatively powerless to change any of these factors, we cannot address this topic without acknowledging how much therapy is shaped by this list. The take away then, is that we need to be careful about being too certain of the exact meaning of any particular client retention number.
Written in December 2011 for the training Centennial Counseling Center clinicians