When clinical psychologist and Advanced Certified Schema Therapist Anna Balfour, DClinPsych, LPC, was asked by a client early in her career if she would see her friend’s son, after considering dual relationship issues, she agreed, as it felt difficult to say no. The young man was struggling with anxiety, and this was well within her specialty.
However, it was clear after a few sessions that there were some other things going on. Extreme OCD being one, and a reluctance to consider change being another, which creates a sometimes insurmountable challenge for any therapeutic relationship.
It didn’t take long before her new client was draining her energy to the point where she began to dread each session. It didn’t help that the only time they could schedule a session was in the evening after a long day, the worst time to meet with a challenging client.
“I began putting more limits in place about when I’d be available. If I went on a week-long trip somewhere, I’d tell my client I wouldn’t be available for two, but I felt bad for him. He didn’t have any friends and had come to see me as his only friend. It was a very difficult situation.”
Their relationship didn’t end until Dr. Balfour moved to a different region, giving the young man no choice but to find another therapist.
“As I progressed through my career, I got much better at sensing at the very beginning who would be a good fit for me as a client,” says Dr. Balfour. “Although a lot can be said for meeting your clients where they are, it’s also important to recognize clients that are going to take too much out of you as a therapist. In most cases, clients will appreciate it if you refer them to a therapist who’s better suited to care for them.”
Finding your best-fit client is an art, requiring sensitivity, the willingness to say “no,” a network of therapists you can refer to, a deep understanding of your own strengths and weaknesses, and good supervision. If you get all of this right, you’re rewarded with a practice that hums along smoothly, helping your clients and fulfilling you as a therapist.
Today, we’re looking at some different strategies you can use to better determine your best-fit clients.
What is a best-fit client?
According to clinical psychologist June Wolf, PhD, as stated in the APA article Deal with clients you don't like, "You don't have to like a person to do a good job as a therapist, but if you actively dislike somebody, it's much harder to do a good job."
The concept of finding a best-fit client isn’t new. The question posed in the Journal of Consulting Psychology article Strategy of outcome research in psychotherapy (1967) by G.L. Paul, “What therapy, by whom, is most effective for this individual with that specific problem and under which circumstances?” presents a formula that might be used today to find the “best-fit” client for any practice.
In fact, it might be considered even more pertinent now considering the greater number of care modalities and specialties.
When attempting to ascertain whether or not a potential client is a good match, it’s a good idea to start with broad brush strokes and gradually refine your selection process. You might decide that how nuanced you are in making your decision depends on your practice’s current performance. If your client roster is full, you can be more discerning. When you’re just starting out, you’ll likely take on a wider array of clients and find it harder to say no. How you ultimately choose your clients will likely change throughout your career.
Here is a graduated list of questions to ask yourself about potential clients, from macro to micro:
- Has your training specifically prepared you to provide the care this client needs? Not all therapists have been trained in the highly specific needs of trauma clients, for example, or the unique approach necessary for children and adolescents. If you’re trained in a specialty, or multiple specialties, it makes sense to connect with those who need your expertise.
- Does the client have an issue that you know you’re not equipped to handle? This might be due to a personal preference; you know you don’t like caring for clients with depression. Or you might need to consider the possibility of transference. If you’ve just gone through a difficult breakup, and a potential client contacts you, needing help with a similar breakup story, you might decide it would be impossible to offer objective feedback.
- Are they able to meet at times that work with your schedule? Part of good practice management is setting and sticking to a schedule that works for you. Even if a potential client is someone you’re eager to work with, if they can only meet in the evening, and you’re dedicated to having dinner with your family, it might be better for both of you to refer them to someone else.
- Are they amenable to your style of communication? Some clients will want to be able to text or email you between sessions. They might require a response within an hour. If you’re okay with that, then great. But if you know that you don’t want to feel as if you’re on call, this might be a client you can only take on if you set definite communication ground rules.
- Do you like this person and feel you can work with them on a regular basis? Just because you don’t agree with a client’s views or find their personality off-putting doesn’t mean you should automatically write them off as a client. Current interim dean and professor at Gordon F. Derner School of Psychology at Adelphi University, Christopher Muran, PhD, specializes in the study of “ruptures in the therapeutic alliance.” In the APA article mentioned above, he cautions against writing off a potential client just because there’s not an immediate rapport. "There are certainly plenty of moments when you dislike your patient or dislike the position they're taking. Very frequently that is a momentary thing," says Dr. Muran. "Early struggles could be a bad prognostication, but therapists could also turn these struggles into transformative experiences for their patients, depending on how they negotiate them."
Use a secure contact form to learn more
So what’s the best way to decide if a potential client is a best-fit client? It would be nice to be able to offer a free 30-minute session during which you could both ask questions. However, you might not feel your practice could absorb this much time gratis, even though it could save you down the road.
Another option is to collect information upon initial contact through your website contact form and follow up with a brief phone call.
While many therapists have a contact form on their website, or use the contact form on a directory site such as Psychology Today, many of them aren’t using the forms correctly, or even using the correct forms.
If you use a standard contact form on your site (one of the free plugins, WordPress, for example), most likely, it isn’t secure. This matters because HIPAA requires you to secure all protected health information (PHI), even if you haven’t established a relationship yet with the potential client. A typical web form collects information that travels from the client to the form service to you. If the form service isn’t handling the PHI securely (and unless you have a signed Business Associate Agreement with them, they probably aren’t), the PHI is vulnerable. A secure contact form on your website ensures that your communication with a potential client is secure from the start.
Having a secure contact form also frees you to ask more detailed questions that qualify the person as a best-fit client. Here are some tips for using Hush™ Secure Forms for encouraging potential clients to submit detailed information that can help you make the decision to offer your services:
- Open-ended questions. For example, “Describe a recent event that caused you anxiety.” Or “What relationship would you like help with and why?” Posing these questions with a Long text field on the form gives your client plenty of room to express themselves. And for you to gauge whether or not they’re someone you want to work with.
- Conditional visibility. You want your form to be engaging, but not all questions make sense for everyone. If you’d like to screen some potential clients for depression but not all, you can use conditional visibility to make a link to your PHQ-9 depression screening appear if the respondent mentions “depressed,” “depression,” or “sad,” in their answers. Conditional visibility tailors the form in accordance with your clients’ responses, making it very useful for drilling down to the finer details of what they need.
- Self-administered questionnaires. Hush™ Secure Forms offers a number of these forms in the template directory, including the PHQ-9, GAD-7, AUDIT, and PTSD Checklist for DSM-5 (PCL-5). These forms give you a calculated score upon submission, giving you greater insight into a potential client’s condition.
Once your potential client has filled out your contact form, you can then follow up with a brief phone call or telehealth session to make that final decision of whether or not to accept them as a client.
Have a referral form ready and don’t be afraid to use it
“I often received warm thanks when I had to turn down a client but referred them to someone I knew would be a great fit for them,” says Dr. Balfour. “If you are the client’s first connection with a therapist, having plucked up the courage to reach out, it’s good practice to be courteous and helpful if you turn them down. Also a client wants a therapist who is eager to work with them, not a therapist who’s dreading each session.”
For this reason, it’s wise to expand your network of other therapists in your area so you know who does what. Then, when you feel a client wouldn’t be the best match for you, you can confidently refer them to another therapist.
Ideally, you want everyone to get the care they need with the right therapist. That therapist may or may not be you.
Handled with care, informing a potential client that you don’t feel you’re the best fit doesn’t have to be traumatic for either of you. Referred to a better-suited therapist, the client will get the help they need, leaving you free to spend your time and energy with clients you can help with your unique qualifications.
Hush™ Secure Forms can help you find your best-fit clients