On being a victim of your own success


This blog has been written by Adam May, who has an independent CBT Psychotherapy practice and is a partner in CBT Psychotherapist Briefings.
Why do we worry about running out of clients? I’ve worked in private practice for nearly thirty years. Business has been good. I haven’t been short of clients since the early days but, whenever my waiting list grows shorter, I start to sweat.
From conversations with other practitioners, I know I am not alone in this, and yet, lack of work is seldom the cause of private practice failure. In fact, it’s the reverse. Those of us who go into private practice are generally amongst the more effective practitioners. Colleagues who aren’t that good stick with their secure NHS jobs.
No, the problem in most private practice is not too few clients, but too many. The better you are, the worse that problem is likely to be. Things are quiet to start withbut then your practice builds because of word of mouth recommendation. The more people you see, the more people there are out there making those word of mouth recommendations.
Before you know it, you are running around like a headless chicken wishing there were more hours in the day. Couple this with the tendency to worry that the supply of clients might some day, some how, dry up and you have a recipe for a burnt out practitioner.
To avoid the headless chicken experience, you need to work out how many clients you want to see each month. Decide on an upper and lower limit and manage your appointments around these figures. It’s no good giving people advice about healthy living, and how important a good work/life balance is if you’re not doing it yourself.
I don’t know about you, but I only have a vague idea of how much money is in my current account, and yet I never go into the red. Clearly, at some level, I do know how much money there is. By the same token, I have a sense of how long it will be before I will have spaces for new clients. Some clients come for longer than anticipated, and some for less, but I am usually about right.
Like so much of delivering good service, waiting list management is all about managing expectations. I make a note in my diary at the beginning of each week telling my office how many new clients to book in.. And usually let people know that the wait may a bit longer – that way they are pleased if they’re invited to come a bit sooner, and they never wait longer than the time initially agreed. Most people don’t mind waiting, so long as they know when their appointment is, and they feel confident of a good service.
This system works for me as well as for my clients. I charge for all cancellations at less than twenty-four hours’ notice: no excuses and no exceptions. That gives my office time to call up the next person on my waiting list and offer them an earlier slot. That means every available slot generates income pretty much every week.
Established clients are amazingly loyal. I am not the only psychotherapist who has had to take a significant amount of time off due to sudden illness and found that the majority of their clients patiently wait until my return.
Very few people decide not to wait. There’s good logic in them taking their place in the queue. If my competitors don’t have as many people wanting to see them, there’s probably a reason for that.
I reckon I am better off without those people who can’t wait a few weeks to sort out problems that they may well have had for several months, if not a lifetime. People with frustration tolerance that low need to see someone accredited by the Magic Circle, not the British Association of Behavioural and Cognitive Psychotherapies.
Now, can anyone recommend me a decent CBT therapist so I can do some work on my pesky, irrational thoughts about client numbers suddenly dropping off?
© Adam May has an independent CBT Psychotherapy practice on Anglesey in North Wales and is a partner in CBT Psychotherapist Briefings. Email adamatclothhall@gmail.com.
Sarah Rees and Sophie Wood will be presenting the “Four Pillars Of Building A Resilient Caseload In Private Practice” webinar at 5pm-6.30pm, on Monday, October 15th 2018 for CBT Psychotherapist Briefings: https://www.eventbrite.co.uk/e/4-pillars-of-building-a-resilient-caseload-in-private-practice-tickets-49190982553