3 Reasons Why We Lose Clients With 5 Solutions to Increase Retention

In a client survey, we received the following feedback: “I’ve had a hard time reaching my therapist after the initial visit. As this happened I felt like my willingness to trust her decreased. I have not felt like she was invested or interested in me personally. She has seemed lacking in focus or organization. She has given the impression that perhaps she is too busy, too distracted, or just doesn’t care enough.”

We ended up losing this client. Has this happened to you?


Over time, we uncovered three primary reasons why clients are lost:

  • Lack of Responsiveness. Managing the sessions, billing, scheduling, marketing, and emergency issues can create stress on a therapist. As a result, it’s easy to forget necessary follow up and needed responsiveness.
  • Lack of Perceived Therapist Expertise. In an effort to gain new clients, it’s very common for a therapist to advertise popular specialties they know little about. New clients will inevitably feel the lack of expertise and discontinue.
  • Lack of Felt Therapist Trustworthiness. Trust is built week to week and through diligent follow-up. With a lack of follow-through on previously discussed issues, clients will feel they are in an environment that is unsafe or not important.

Have any of these issues caused you to lose clients? If so, we offer five simple solutions to help improve your client retention.

1. A Safe, Simple and Efficient Intake Process

Most new clients feel overwhelmed or anxious when searching for a therapist, as they’re getting ready to open up their deepest feelings to a stranger. To ease their search, here’s what we suggest:

  • Make Reaching Out Simple.  Clients will have a driving concern that they would like addressed right away. Make sure you or your scheduler can quickly understand their issue and identify if you’re a good fit for them, or not.
  • Schedule within 5 Business Days.  First session hold rates dramatically drop off when  scheduled beyond 5 business days of initial contact. In most cases, it results in no-shows, leaving a space open that you could have otherwise filled.
  • Send and Complete Paperwork Electronically.  SimplePractice, for example, makes this extremely easy by providing a completely paperless client intake. New clients come in ready to work without distraction.
  • 24-hours Before the Appointment. Call the client to verify the appointment, follow-up on paperwork, offer directions, and assure them that they made a wise choice by seeking help from you.

2. Create an Amazing Clinic Experience

Cliché but true: First impressions are everything! How your clients feel early in the therapeutic process makes a difference in long-term retention. The therapeutic process begins the minute a client sees your website, listens to your voicemail, or talks on the phone with you. When they arrive at your clinic, they begin to analyze the decor in your entryway and the atmosphere in your office.

Ask yourself: What do they see? What are they hearing? Do you have music playing in the background? Is it clean? Can they hear others talking outside of the room? Is there comfortable seating? How is the temperature? Can you offer blankets or water? Go through the steps as if you were there for the first time and try to see what a new client would see. Would you feel safe with yourself?

3. The First Session: Set Proper Expectations

When their expectations for therapy are drastically different than reality, dropout is much higher. As difficult as it may be for the client to hear, setting realistic expectations early on is extremely important to a long-term relationship. To set expectations, we like to use the following questions in a first session:

  • What led you to therapy?
  • If you could change your situation, what would you like to change?
  • What are three goals you would like to achieve in the next three months?
  • What would the changes mean to you?
  • What happens if nothing changes?

When expectations are set regarding the process and the expectant roles of the client and therapist, the client will feel hope, be empowered to move forward and will engage in the therapeutic process at a deeper level.

4. Form an Ongoing and Strong Therapeutic Alliance

A strong therapeutic alliance is done through mutual trust. Clients need to feel that you are fully present, nonjudgmental, and empathetic in helping them. To build this relationship:

  • Listen and Follow Closely.  Let them be involved throughout the healing process and continually check in to make sure their goals haven’t changed.
  • Prepare for Sessions.  Start on time and finish on time. Let your clients know that you’ve been expecting them and that you are prepared for their session. Therapy with no clear goal can be bewildering and often frustrating for clients. It leaves them questioning, “Why am I here? What am I doing?”  
  • Keep a Waitlist.  If your schedule gets full or your client can’t get in when they want, keep a waitlist and watch for openings. When you reach out to a client about an opening, it lets them know you were thinking about them in between appointments and that you care about their healing.

5. Follow Through

This is often the most difficult part of this process, yet it’s one area that can set you apart from other therapists.

  • Once a Session is Complete, Give your Clients out of Session Work.  When they come back in, be prepared to follow up on how it went. Many therapists make the mistake of thinking the client will bring it up, while the client is waiting for the therapist to address it. It also helps the client feel like they are making progress from week to week. When you follow up on the past appointment with a client, it lets them know that you are aware of where they are and that you care about their progress.
  • Be Responsive.  Just as important as following up on past sessions, make sure you also follow through with returning phone calls, emails, and sending the client information that you promised them.

The Result: Your clients will feel safer, stay longer, and refer others.

Addo Community leader, Rachel has a 95% retention and a 5% cancellation rate. Here’s a link to an interview with her discussing her best practices:  https://addorecovery.wistia.com/medias/nq462lup15

Remember that every interaction between you and your client is building a foundation of trust. When your clients feel heard, cared about, respected and well informed on the process, they are more likely to come back. Satisfied clients also refer friends and family, and are more likely to continue even when other barriers such as money, time, childcare, and distance get in the way. Along with focusing on how to bring new clients in, your time and efforts are well spent making sure your existing clients are getting superior care with you.


This post was written by Eric Red. Eric Red is the Managing Director at Addo Recovery. Addo offers a free community for therapists with on-demand courses, group therapy content and peer support.

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