Trying to get clients to see you regularly, until their issues are resolved, can present many challenges. Please read on for some suggestions on how to handle this vexing issue.
Clients readily make the first appointment. At that time, they are the highly motivated because they are in the greatest amount of pain. However, once they start feeling better after a few sessions, life starts to get in the way of their appointments. This can be very frustrating, because we are finally getting somewhere and the client disappears for several weeks!
First, I think it’s important to remember that the client’s goals and our goals may be different. Even when we do a proper goal-setting session, we generally want more for our clients than they want for themselves. For them, it may be enough that they are feeling a bit better and can pretty much function. So, it could be that they are finished and we don’t realize it. Continual assessment of progress as well as explaining to clients the importance of a final session to anchor changes and develop a relapse prevention plan is the antidote.
Secondly, because their pain has been reduced clients naturally begin to think counseling doesn’t need to be as much of a priority. This is actually a good sign, because it means that clients are getting better. At this point, instead of pushing for more sessions (which could increase client resistance) it would be a good idea to discuss reducing their frequency. It is much better to be proactive about this, so that the client perceives you are paying attention to the specifics of their case, and also because treatment decisions like this should be made collaboratively.
Specific Scheduling Tips
- During the first session, when clients are the most motivated, discuss the importance of regular sessions. You should also tell them about the research suggesting that having more frequent sessions in the beginning leads to longer-lasting change.
- If you haven’t seen your client in a while, call them to follow-up. Best practices generally dictate consistency; so develop a process with rules and stick to it. For example, if you’ve been seeing someone weekly, you may want to call when more than 2 weeks elapse without an appointment.
- For ease of scheduling, offer a variety of morning, evening and weekend appointments. Also, consider implementing an on-line scheduler. The easier the scheduling process, the more likely a client is to make an appointment.
- If you go on vacation, be sure to notify your clients well in advance so they can schedule around it.
Lastly, it is always possible that the client has not rescheduled because you were a poor fit therapeutically. Barring any clinical error on your part, sometimes the “chemistry” just isn’t right. If clients don’t feel comfortable or connected to their therapist, then they should find another one.
To find out why clients don’t reschedule, consider implementing performance metrics such as those developed by Scott Miller to assess the therapeutic alliance and efficacy. This type of information will tell you if you need to make adjustments.
Yours in the Joy of Knowledge,
Dr. Barbara LoFrisco
