Have you ever felt weighed down by the intensity of your client load? Or are you wondering why you are not getting enough clients? When you think of the range of clients you see during a regular week, which of your clients come to mind as the ones that ‘consume’ most of your energy? Can you think of any clients who you take to supervision predominantly and recurrently, and spend an above average amount of time in supervision on?
Michael Soth gave us a fascinating workshop, which gave us food for thought when considering some of these questions about to how keep a therapy practice sustainable. Therapy is dramatically different to any other profession, so we need to find a way to set up a practice that moves beyond simplistic frameworks and business models borrowed from other professions.
Finding and keeping clients
The first impression
Our relationship with clients begins when they first hear about us. This can be through our internet presence (website, social media, or various therapy profile sites), word of mouth, or referral. The client has a first perception of the therapist, which has an inevitable impact on what they expect from them.
It is important to consider which types of clients you are inviting, and which ones you are unconsciously turning away. This can come with how you present your modality, your description of how you work, right down to how your website looks. It is important to make this a conscious process; it is okay to select your clients as long as you are aware that you are doing it and understanding why.
The initial interview sets the precedence for what the work will be like. Consider how you present yourself in an initial meeting. Do you start off with an assessment (which immediately puts you with the medical model)? Do you show clients what therapy will be like with you? What does the business section of your interview section look like – are you clearly drawing out the boundaries, or are you more loose (which will reflect in the work)? If you have a fixed position (e.g a dislike of assessment tools) then you will put certain clients off. Is this okay with you? Or would you like to have more of a range of clients?
Anticipate the grilling that might occur in the initial interview from clients: this is understandable – they are paying! If the client is asking a lot of questions about how qualified you are, or what they can expect – then try to go deeper… Michael suggested that rather than answering a ‘superficial grilling’, we should dig for the questions that the clients are really asking of us.
Managing your caseload
The emotional cost of providing therapy and the habitual position
Consider the dynamics that are set up between you and your clients. These dynamics have an emotional impact on how heavy your client load feels.
All therapists ‘construct’ therapy – consciously and unconsciously – through the lens of their own childhood scenario and family system. We all practice from our ‘habitual position’ in the world, which was developed in our childhood – our first training as a therapist! The particular intricacy of each client-therapist relationship can hook into the therapist’s ‘habitual position’ and become exhausting. The clients wounding may reflect your own wounding, or trigger something you didn’t know.
The more aware we can be of subliminal communications, implicit messages and reactions, and pre-reflexive body-mind responses, the more likely that we can process them more comprehensively and consciously. This means that the way we pick up on these dynamics and process them can be essential in creating a sustainable practice. We will be moved and changed by our clients, but this needs to be sustainably managed. For more on these client-therapist dynamics, see our blog on counselling when stuck.
How to manage changes, or endings
When clients are thinking about terminating, to what extent do you think about their process or about the income you stand to lose (it’s uncomfortable, but true that it does happen!)? We need to be aware of our own needs, but ultimately it is the therapeutic process that is of utmost importance. We must always consider the following when the client suggests ending:
- Are they ready?
- To what extent was this communicated early on?
- Could this be down to therapist-client dynamic? What is being communicated?
- Is this an enactment of their previous wounding?
Remember that if a client is leaving when there has been a rupture, there are transformative opportunities that could be missed if you do not leave the space for a repair to happen.
As always, ensure that you are consciously processing all the therapeutic dynamics in the ending.
A final point on the internal therapy dynamics
Think about ways to organise your practice and arrangements to suit you and the work of therapy. A sustainable practice requires a therapist who is aware of how the internal therapy dynamics will affect them as a person. Therapists should organise their practice accordingly. We need to accept that ruptures are inevitable, rather than worrying too much about them (taking them home with us night after night). If rupture is welcomed and accepted – your emotional load may be lifted.