How long does it take to become a full-time therapist with a full-time caseload? In my experience, when one is starting from scratch in a new community it takes about two years to get to a decent and steady caseload of 25 clients per week. That’s just how long it takes. It just takes a while to build the depth and number of referral relationships you need to sustain a comfortable caseload. And that is if you are working hard all the time. I have seen many therapists think that by their hard work they can shorten that two-year build-up. I’ve rarely seen it done from scratch in a shorter time frame. It just takes time to build a solid caseload. And yet, there are exceptions. . . .
First exception: Your old employer
There are exceptions that can shorten that time frame. 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 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 come 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.
In the end, plan conservatively and work diligently on your marketing initiatives. 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.”
For more on managing that issue of too many referrals, see the post “The dilemma of success: Do it myself or delegate.”