Client Retention: have you heard the phrase?  Perhaps the owner of your therapy group practice has been talking to the team about retention rates, or asking you why certain clients are terminating services after a few sessions.  If so, we’d like to share with you why client retention is important, not only for the client’s well being and the practice’s revenue, but also for you as a therapist.

What Is Client Retention? 

Let’s back up a bit and clarify what we mean by client retention.  Client retention refers to the number of clients who continue therapy in a given time period. The more clients who continue sessions in that time period, the higher the retention rate, and the more clients who terminate in that time period, the lower the retention rate.  

A good mental health group practice goal is for each therapist to have a minimum of a 90% retention rate and ideally 95% or higher for individual clients, and to have an 80% to 90% retention rate for couple clients.  A 90% retention rate means that only 10% of clients on a therapist’s caseload are terminating in any given time period.  Client retention is one of the most important factors in helping clients achieve long term results, reducing therapist stress and burnout, and growing the practice. 

We will always discuss client retention in the context of what is therapeutically best for the client.  Ethical client retention focuses on retaining clients only if the therapist is a good fit and only until the client has met their therapy goals. 

In this blog post, we will focus on how client retention can help you reduce your stress and burnout, boost your income and make it more predictable, and increase your overall job satisfaction. 

Benefits of High Client Retention Rates for Therapists: 

The majority of therapy clients are people you know well and like.

You’re a therapist, but you’re also a person, and no person likes to spend the majority of their working hours with people they don’t like.  

At Confident Private Practice, one of the ways we work with therapy practices is by helping them develop their Ideal Client Avatar, which helps them identify the type of client with whom they most like to work.  To some extent, this will be set by your practice.  They may specialize in helping couples or working with clients with a particular mental health issue, for example.  However, to some extent, you may be able to tell your practice owner that you really enjoy working with first generation immigrants, couples dealing with major life transitions, or any demographic, special need or presenting issue.  

Not every client is going to be your ideal client, but when one starts working with you, you want to keep them around!  Of course, client retention is always in the context of what is therapeutically best for the client, so it’s imperative that we approach keeping them around from the mindset of first asking what is best for them.  However, it’s not wrong for you as a person to enjoy the work you do with certain clients- whether it’s their presenting challenges, their personality or the fulfillment of the work you’re accomplishing together- and for you to desire to have those clients feel that keeping you as their therapist until their therapy goals are met is valuable to them.  

High client retention means less stress for you to maintain existing therapeutic relationships rather than constantly build new relationships:

Again, you’re a therapist, but you’re also a person.  You spend many of the first therapy sessions with new clients learning their history, their needs, and their personalities.  Building new relationships is emotionally taxing work.  Many therapists report that while they would like to build their case loads for financial reasons, they have to limit the number of new clients they take in any given week or month so that they can take the time to integrate the new relationships.  

Retaining clients whom you like and are working well with you is less stressful than building new relationships.  Of course you’ll always lose clients and need to replace them.  After all, the goal of therapy is not to need therapy anymore.  However, having a lower turnover rate means that when you do integrate a new client, you can do so from a place of abundance of emotional bandwidth. 

High client retention means having a full therapy schedule, which results in more income:

Often therapists are wanting more clients on their caseload, and waiting on their practice to provide those clients.  This sometimes creates tension between therapists and practice owners, as therapists are relying on practice owners to provide those clients which are the therapists’ only source of income, and practice owners want therapists to do more sessions with the clients they already have due to the cost of marketing to new clients. 

This tension may be the reason your practice is talking about retention rates, and might be using PracticeVital to give you hard numbers about where your retention rate stands.  While it may feel overly administrative or too businessy to talk about retention, your retention rate directly affects your income, and that’s a major aspect of anyone’s life.  

Knowing your retention rate can help you and your practice owner have candid conversations of how your income can remain consistent or increase as you learn to retain clients until their therapy goals are met.

Let’s look at the case of Jane, an AMFT from Oregon: 

Jane’s rate is $125 per session and she does an average of 10 sessions per week.  She receives 40% of session revenue, making her gross income an average of $2172 per month (4.345 weeks per month).  

Jane has 20 clients on her caseload, who are a mix of weekly and biweekly clients.  Her retention rate is 70%, which means she loses around 6 clients per month. 

Jane would like to be doing 15 to 20 sessions per week, but it seems like every time the practice provides her with a new client, another client terminates.  She just can’t get ahead and is frustrated the the practice isn’t sending her more clients.   The practice owner says she spends around $1800 each month to replace those clients, and that she just can’t put any more money into marketing than she already is.

After the practice owner brings to Jane’s attention that her retention rate is low, she implements some techniques and builds some skills provided by Confident Private Practice.  Jane raises her retention rate to 90%. 

Jane is now only losing 2 clients per month, and still gaining the 6 per month that the practice can afford to send her. 

• Month 1: Jane has 24 clients on her caseload and is doing 12 sessions per week. 
• Month 2: Jane has 28 clients on her caseload is doing 14 sessions per week. 
• Month 3: Jane has 32 clients on her caseload and is doing 16 sessions per week. 
• Month 4: Jane has 36 clients on her caseload and is doing 18 sessions per week. 

Month 5: Jane’s new skills also result in her being more organized overall, and many of the techniques used to improve retention also help her keep more weekly clients.  She’s now doing over 20 sessions per week, even after her caseload drops to 30 clients over the holidays. 

Within 6 months, Jane is making a minimum of $4345 per month. 

The practice owner’s revenue has also doubled, and she now spending 16% of revenue on client acquisition instead of 33%.  

Client retention can make all the difference in a therapist’s income being viable.  In addition to growing your caseload, retention makes it easier to raise your rates with your existing therapy clients.

High client retention means you can raise your rates with your therapy clients:

Those clients who know you and love you and are so happy that you are their therapist will be happy to pay and additional $5 or $10 per session every 6 months. 

This means Jane would be able to raise her rate with her existing clients by $10, for a total of $135 per session, and her new monthly income would be $4692.  

High client retention means a predictable schedule in your therapy work:

Did you catch how in Month 5 Jane’s new skills also result in her being more organized overall, and many of the techniques used to improve retention also help her keep more weekly clients?  

Another benefit of retention is a more predictable schedule, allowing you to have a healthy work/life balance.  

One of the techniques Confident Private Practice recommends to therapists to improve retention is to have clients scheduled for standing sessions at the same day and time every week.  This habit building is good for clients therapeutically and also creates predictability for both you and the client. 

When you are part of the client’s weekly routine, they discover more value in the therapeutic process.  As therapy becomes more valuable, they look forward to it.  As they continue to show up, they go deeper in the work.  The deeper they go, they more they discover they have additional therapy goals to meet.  As you help them meet those goals, they succeed in other areas of their lives, including executive function, resulting in the ability to keep habits and quite possibly making more money in their own work.  The more they make, the easier it is for them to pay you weekly and to continue to come to therapy.  Even if their results are never financial, they choose the value of therapy over the potential value of other expenditures.  

For you, making a living wage working with clients you like on a predictable schedule, means less stress and more time for pursuits outside of work.  You don’t have to be constantly wondering if your clients are going to show up, or texting them for rescheduling.  You can have a predictable work schedule, and make time for family, friends and hobbies.

High client retention means a feeling of fulfillment in your job as a therapist:

While time and money are important, we know that you got into this work because you want to help people.  

High client retention can be highly fulfilling for you, as you’ll have the opportunity to see clients through a complete season of their lives and wrap up the relationship with positive feelings on both sides. 

Therapists are people, and when clients drop therapy without explaining why, it hurts.  You can put on a professional face and accept that this is just part of the job, but it still hurts to wonder if you could have done something differently.  

Even when you know the reason for termination, if you know the client hasn’t met their goals, you may feel responsible in some way.  You may wonder about them weeks or months later and hope they are ok. 

When clients continue sessions until they meet their goals, you receive the gift of knowing your good work made a lasting impression in someone’s life.  You’ll experience a feeling of closure, as you wrap up each final session with expectations met, warm goodbyes and well wishes on both sides.   

Ready to Improve Client Retention?

If this post has been helpful to you in understanding how high client retention can benefit you, here’s what you can do next: 

If your practice is not already using PracticeVital, present it to your practice owner!  PracticeVital is a fully automated metrics dashboard that integrates with your EHR to track key metrics for your practice, including retention rates. With PracticeVital, you can ditch the spreadsheets and jump right to understanding your rate of retention, your average number of client sessions, and how those numbers are trending over time and comparing to others in your practice. 

If your practice is using Practice Vital and you know what your retention rate is, let’s work on building the skills to improve it.  Tell your practice owner about Confident Private Practice.  We help mental health therapy group practice owners grow their businesses, reduce their stress, stop wasting time & money and become financially stable.  We offer a live training on increasing retention rates to help practice owners and therapists build the skills they need to retain clients until therapy goals are met, increasing practice revenue and therapist salaries and reducing client acquisition costs.  

Emily Ferguson is the founder of Confident Private Practice. She has been deeply involved in the therapy world in many capacities: an intake coordinator, an operations manager, a business coach and a client. You’re an amazing therapist: you care deeply about your clients, you do good work in the therapy office, and you’d like your blood pressure and wallet to reflect the hard work you’ve done. Emily would be honored if you would allow her to take the stress of running the business side of your practice off your shoulders. Let CPP handle that mental load, so you can do what you do best: be a therapist! That’s good for you and good for your clients.