Several good things come from the ability of clinicians to retain existing clients, i.e. the art of client retention. From a business standpoint, clients staying in a clinician’s schedule helps the clinician maintain stability in both schedule and income. And from the client’s point of view, good therapy allows clients to explore issues further and more deeply.
Who decides when therapy ends?
Therapists frequently complain about the insurance company’s power over the therapy process. Clearly insurance companies do determine fee schedules. And in many cases they determine therapist a client may see. And in direct and indirect ways they even have a say when therapy is terminated. What therapists call “client retention” insurance companies call “utilization”. And they view it as a bad thing. Insurance companies argue that they must use rigorous cost-containment strategies. Otherwise the “worried well” would collude with their therapists to “overuse” therapy. They believe in cost containment. Not in therapists and clients.
The issue is, who decides what “overuse” is?
I would counter the insurance company’s concern this way. What I observe is that most clients do an internal cost/benefit analysis before nearly every session. They frequently questioning internally, and sometime with their therapist, whether they are getting as much as they should from the therapy. From what I can see the process of therapy is inconvenient enough and emotionally difficult enough to counterbalance the worst overuse of outpatient psychotherapy. Outpatient utilization doubtless would increase without cost-containment strategies. But I believe the cost-containment strategies block needed and essential treatment to much of the time.
Furthermore, I believe that a therapy that regularly passes a client’s scrutiny, should not be restricted or terminated by someone else. Can an insurance company or even the therapist him- or herself have a more appropriate perspective about the value of the therapy? In my view, it seems obvious that clients are in the best position for deciding whether the therapy is providing the appropriate value to make continuation worth the effort. In my perfect world, the client should be the one to decide when therapy should begin and when it should end.
Dependence or excellence?
Of course some will worry that unconstrained therapists will frequently hold clients in therapy beyond what is good for them. While I have heard much about these worries, I have rarely seen it in the real world. Rather than fostering dependence, what I commonly see are therapists who accidentally diminish the quality of therapy from what it might have been by constraining the length of treatment.
My goal then is that rather than extending therapy by fostering dependency, extend therapy by its excellence. Let clients choose to stay because they are able to get more of what they really desire in the therapeutic experience. In the long run, that seems like a good outcome for the individual and society.
Written in December 2011 for the training Centennial Counseling Center clinicians