How long does it usually take to build a full-time caseload? In my experience, when one is starting from scratch in a new community and one takes the typical approaches to build a caseload, it takes about two years. That will get you to a decent and steady caseload of 25 clients per week. That’s just how long it takes.
Why? It just takes a while to build the depth and number of referral relationships you need to sustain a comfortable full-time caseload. And that is if you are working hard all the time.
But there are ways to accelerate this growth process.
I have seen many therapists think that by their hard work they can shorten that two-year build-up. It can be done. Here is how to become one of the exceptions to that two-year timeframe.
First exception: Your old employer
There are exceptions that can shorten that two-year timeframe to a full-time caseload. First, if you begin with an already well-established caseload the time frame will be shorter. In this case, you are not really starting from scratch but building on what you already did in some other setting. But remember that contractual constraints, such as restrictive covenants, may make this difficult. Sometimes existing employers will allow a buy-out of such restrictions. Ask but do not assume you know what your existing owner will expect. Communicate and negotiate.
Second exception: Hospitals and churches
The other exception to the two-year rule to a full-time caseload is when you are going to be backed by a large organization that knows you well. For example, launching from a position on the staff at a psych hospital can work well. Be sure to stay in the geographical service area of the hospital. And of course, it helps if you are well-liked by the staff and psychiatrists at the hospital.
And yet even then your window for being the favored practice will diminish over time as new staff comes on. So while you can, use these connections as a springboard. They are temporary, and you need to work at diversifying your referrer base as soon as you can.
It is a similar story if you had a position on the staff of a large church. Most large churches have a system for referring out to mental health professions. The church can give you a temporary boost. But as with the hospital, you will become less well known as time goes on.
And of course, not all churches are comfortable referring to mental health providers. Some see client/parishioners’ issues as either God’s vehicle for salvation or as derived primarily from a spiritual source. Know your church and their theology of mental illness. That theology will have a major impact on your referrals.
Third exception: You become a consistent marketer
Additionally, the best method for developing a full-time caseload is to become a consistent marketer. My organization spent considerable time and effort teaching all our therapists to market. I have a number of posts on how we did that. See for example Marketing favorites that are not a big stretch and A community-based marketing method: Community Connection Plans.
The real answer here though is consistency in doing your marketing. And marketing has to continue even once you get too busy to do it. (See Learning to manage myself: Solving my self-imposed roller coaster for more on managing yourself once busy.) Those that grow, learn how to do the right things even when stretched thin.
A full-time therapist with a full-time caseload
Hence developing a full-time caseload is, first, a matter of planning conservatively. Then working diligently on your marketing initiatives. And thirdly, doing so consistently.
You want to get to the place of having “too many referrals” as quickly as you can.
For more on how to build a referral network, see the post “Creating demand for your services.”