Strategies for engaging clients and improving outcomes

As Therapists/NPs/Mental Health Support Staff, we need to make sure we are doing what we can to not only engage the clients who reach out for help but also assist them on their journey to healing until they are ready to graduate from treatment due to successful completion on their therapeutic goals.

Let’s start with briefly exploring early termination of clients (“losing a client,” “being fired by a client,” “getting ghosted by a client,” etc).  Virtually all clinicians have a strong desire to keep their clients in treatment until termination becomes a mutually agreed-upon decision based on their therapeutic progress.  When clients threaten to leave therapy prematurely, most clinicians refer to this event as “losing” their clients because they are deeply concerned about the loss of income, the loss of personal self-esteem, and the loss of professional status.

Let’s look at some facts:

• According to various studies, between 20% and 57% of clients who start therapy do not return after their initial session.
• Reasons for early termination can include feeling uncomfortable with the therapists, not perceiving progress, financial concerns, or a lack of belief in therapy’s effectiveness.
• Clients most likely to drop out early include those in their 20s and clients seeking therapy for personality disorders and eating disorders.
• Research also suggests that novice clinicians are the most likely to lose clients prematurely, with some reporting dropout rates as high as 75%.

“Even the most expert clinicians using treatments with the strongest empirical support cannot be effective if patients drop out of treatment prematurely,” says Roger Greenberg, PhD.

What may I have done or not done as the therapist to “lose” clients?

• Have I failed to listen to my client and talked too much instead?
• Have I hastened to answer clients’ questions when I would have been better off exploring their motives for asking?
• Have I prevented my clients from voicing anger, sexual feelings, and other affects because they threatened me too much?
• Have I directly or indirectly acted out my own contempt toward clients?
• Have I failed to appreciate the meaning of my clients’ transference reactions and other means of resisting my help?
• Have I engaged in countertransference through my desire to “rescue” my client and therefore become therapeutically overambitious?

Take some time during January to think about the above questions and if any of them are areas you can improve upon to assist you in client retention.  Stay tuned as we take a deep dive during 2025 to explore strategies, techniques, and tips, to decrease early termination of clients.

If one listens carefully to the client, they emerge as the best psychotherapy consultant available!

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