Don't Be A Client Hoarder

Today we’re going to travel into the future! Exciting! We’re focusing on when your practice is full to bursting. Now before you say I’m putting the cart before the horse consider that this will actually do some early-practice mindset shifting.

Let’s talk a bit about waiting lists, shall we. It’s a pretty exciting thing to be full. If you’re like me when I first got full, at first you may try to cram new clients in to spaces without realizing it displaces current clients. Maybe you loosen your boundaries and work an hour late to make up for that or schedule someone in during your lunch hour. At some point you realize that you can’t keep taking more clients on. It’s a very tempting thing to have a waiting list. It soothes those scarcity fears. It feels like a promise of ongoing success. But let’s take a minute to really look at that.

I’m going to use an extreme but real example. I once worked for an agency that often had a 3-6 month waiting list. We were told to “manage our caseloads” (it pisses me off just to type that because I heard it ALL the time). It felt like there was this line of people banging on the door and it was my job to get the current clients out the door before they were really done with therapy. I would wake up in the middle of the night feeling anxious about the waiting list, as if I was personally responsible. Probably because I tend to work with folks with longer term issues for whom solution-focused therapy isn’t appropriate.  Probably because I really loved doing intense, life-changing work with people and I never figured out how to do that quickly. Probably because I felt pressured every single day to manage my caseload.

Guess what happened when people were finally called for their turn. Sometimes they muddled through the misery on their own enough to make life just good enough that they didn’t feel like they needed therapy. Sometimes they had decompensated so much that they needed a higher level of care than we provided. I still remember the look on this man’s face when he said, “You made me wait 5 months to tell me that I need rehab? What the fuck is wrong with this place?”

Here’s my point: waiting lists aren’t good for clients. If there is another clinician who has availability and is capable of helping your client, I think it’s more ethical to refer them. Sure, if you’re the only therapist within a 60 mile radius who knows how to treat eating disorders then maybe we can consider a waiting list, but that’s probably not the case for most of us. Why should a client wait weeks or months because you’re stuck in scarcity?

Here’s a valid concern: if word gets out that you’re full people may stop referring to you. I have a  workaround for that. If people are referring to you because you have expertise in a particular niche, tell them that though you’re full you are so happy to talk to the client and refer them to some of the other great people you know in your niche. If you have an inner matchmaker this really satisfies and you can leave your friends’ love lives alone.

Yes, this means you are going to be devoting time every week talking to not-your-clients and referring to not-your-practice. This is the part where you feel good about helping people. You’re spreading good will, helping multiple people in need and this will only be beneficial to both your reputation and your karma. You’re also living in abundance and trusting that all the good work you do will keep you full. I’ve found this to be true. Each time someone graduated from therapy or moved away, I got a call within a week to fill in that slot. As you’ll find (and I’ll keep shoving down your throat) there are PLENTY of clients. Keep it flowing!

What's your experience with this? Have waiting lists ever kept you up at night? Were you looking forward to a waiting list?

Allison Puryear is an LCSW with a nearly diagnosable obsession with business development. She has started practices in three different states and wants you to know that building a private practice is shockingly doable when you have a plan and support. After retiring her individual consultation services, she opened the Abundance Party, where you can get practice-building help for the cost of a copay. You can download a free private practice checklist to make sure you have your ducks in a row, get weekly private practice tips, listen to the podcast, hop into the free Facebook Group. Allison is all about helping you gain the confidence and tools you need to succeed.


1 comment

Allison Puryear

Thanks, Amanda! I actually had a dream a couple months ago where I was being told to "manage my caseload." *shivers* I love that for the most part, we get to choose what works for us in our businesses!
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