In March, I attended the Association for Women in Psychology’s annual conference in Salt Lake City, Utah. That’s where I met LeLaina Romero – a post-doctoral feminist clinician working toward licensure as a psychologist at The Meeting Point in Jamaica Plain, Massachussetts. A few days ago she wrote to say . . .
I was thinking about offering a free phone consultation- I’m not in a financial place where I can offer a free initial session! I see that you do this, and I’d love to know how you structure that! How long, how client-driven, etc.
Take good care!
LeLaina”
I love that LeLaina asked this
question because I see therapists in private practice confront this choice every week. I do not offer a free initial session for several reasons . . . .
Ethics
It’s not ethical to inquire about sensitive and personal details if I’m not the clinician on record; of course, some might note also that if I am getting all that sensitive and personal details in that free session, then perhaps I am the clinician on record – whether I ever collect a dime or ever see that person again. That’s not good for my client or for me!
No Strings
I’m not a fan of giving away my time, either. It’s one of my most treasured intangible possessions. It’s what I sell for a living. It’s precious and valuable to me. It’s not even about what I could be earning from someone else during that free consultation. It’s really about my priorities in life. If I am giving a gift of time . . . I really do want it to be a gift – no strings attached.
The truth is that if I routinely “give” a potential client a free hour of my time . . . and I never saw or heard from her again, I’m afraid I might resent it. I know me well enough to know that I wouldn’t really be giving that hour away . . . . I would be expecting or at least hoping and praying that that potential client would be coming back to me! What’s that saying about a gift being something that is given with no strings attached? I believe that. And, I do not want to attach strings of expectation or desperation to any potential client whether she shows back up or not. (That would be closing my eyes to counter-transference, wouldn’t it?)
Fear
Most therapists that I know who routinely “give” that first hour away in a consultation, are doing so out of fear. Clients choose who to work with based on who they trust. It’s as simple as that. If you’ve put enough glue i.e. trust-building moments into that initial conversation, then the clients will follow. If you don’t, then you may end up with plenty of phone calls but appointments never being made or kept.
Free Phone Consultation
And, LeLaina is right. I do offer a free consult on the phone. It’s called The Very First Phone Call I have with someone. That’s because, like any good clinician who is more interested in her clients that in herding the masses into her office, I make time in my day to actually speak to every one of my potential clients that call.
What am I doing with them? I’m screening them, of course! And, they are screening me. They are asking their questions; and I am asking mine. We are sizing each other up to see if we might be a good “fit” and we are consulting each other to make that determination. It’s not much more structured than that. I will spend as much (or as little) time as is needed for me and that potential client to feel good about scheduling that initial appointment.
The “Glue”
I should say that I have worked in offices where the receptionist took care of that initial contact and infusion of “glue.” I have seen that work in one office to the disadvantage of the client and the practice; but, I have also seen that work very well for everyone in a different office. There have been times in my professional life when I have used an answering service as many other health care providers do; and, I have usually not been very pleased.
Ideally, I would answer every single phone call the first time the phone rings . . . but my schedule rarely permits that these days. My schedule is too full. Regardless of who answers your phone calls – whether it is you and someone else – the key is the same. Your potential clients need to be made to feel comfortable, they need to begin to trust you / the person on the other end of the phone. And, if it’s in your practice, then it’s you who needs to make sure that is happening.
So what about you guys? Do you offer a free initial session? A free phone consult? Something different? And, what’s your rationale for doing / not doing so?
Hi Tamara,
Great topic! I offer a free 20 min phone consultation in order to verify that I can be of best assistance to the client and to give them a chance to get to know me a little more. I was offering free 30 minute in-office consults for a particular niche I work with but, like you said, I realized I was trying to “sell” myself – which I hated.
So, I no longer offer free in-office consults. Plus, I’m not sure if the majority of people think this way but when something is giving away for free, I tend to think less of it – especially when it comes to services. I mean, you don’t see highly regarded physicians, therapists or other entrepreneurs giving away their services. There’s definitely something to be said about the impression one can get when they are given something for free vs. having to pay for it. Or, again, maybe that is just me. Thanks again Tamara!
Nope. I’m right there with you, Christine. Free in-office consults just scream “I’m desperate!”
Hmmm, I have never felt this way about the consults! Interestingly enough I have a consult myself for Orthodontics recommended by my Dentist. If the free consult was not there I would never go in, as I want to know what I am buying first. So my question is shouldn’t our client’s know what they are buying first? I guess this was the approach I was taking with the free consults at my practice. Any ideas on this approach or am I seeming desperate because I offer the free consult?
Lyndsey, how cool that your othodontist offers a free consult! Obviously, he isn’t doing any mechanical work with you at that appointment. He’s just talking with you about how he works and what you / he can expect. I absolutely think that we and our clients should know what they are purchasing. That’s called the informed consent process, right? And, that’s a consult that I choose to have by phone rather than in person.
I won’t venture to guess whether or not you seem desperate but if you were my consulting client, I would ask you if you feel desperate or anxious about the possibility of not attracting enough ideal clients to your practice. If you acknowledged that this is at least partially true, then I would ask you if offering that in office consult is in some way an attempt to mitigate that anxiety – your own and not just your client’s anxiety. What I know is that our clients read us just about as well as we read them.
Lyndsey, it is also entirely possible that you have no fears about not having enough clients and that you simply prefer to give your time away in face to face consults. In fact, you may already have more than enough clients (and income) and see this as just an additional service that you provide to your community and potential clients. If this is the case, then it’s likely that you are not perceived as desperate or needy at all! There is nothing inherently wrong (or right) with a face to face consult and it may work very well for you. Just make sure that you are not giving away time i.e. money that you do not have to give away.
And, remember, there is very little about marketing a practice that is one-size-fits-all.
Tamara,
Thanks for the reply! I actually have an almost full practice and have not felt anxious about the consult! I currently don’t NEED new clients but have room in my practice for a few more. I like how you point out that if you are feeling the NEED for clients it may be a good indicator about your own anxiety. I have always liked the more personal face-to-face contact with clients; as it helps solidify the relationship. Whereas I often find the phone consult to lack this piece. Phew, you had me worried there for a minute that I was appearing desperate when I have never felt that way!
🙂 Congrats to you on the success of your practice, Lyndsey! When all else fails, look at the evidence! Whatever you are doing seems to be working! Keep up the good work . . . and thank you for being part of this community – not just sitting on the sidelines but being willing to dive in to the conversations and share what you know or wonder about. I love that about you! (Oh, and I love that killer haircut you have, too!)
I used to offer a free initial consultation but came to the conclusion that my time was valuable and I should be compensated for it. Like you mentioned, Tamara, I started to feel some resentment toward clients thinking they were just after free advice. I do offer a free phone consult but no more than 15 minutes. As I’ve become more skilled I’ve learned that 15 minutes is enough time to screen the client and offer a listening ear so they feel heard and understood.
Good morning, Pam! I do think you make a good point when you say that over time you’ve become more skilled in your screening. That is certainly true for me – in part because I was motivated to get better at it. In the beginning, I think I was so desperate that I took into my practice anyone that was breathing. Over time, I’ve realized that I don’t need to do that, that my clients don’t benefit from me doing that, and neither do I. That’s a little bit embarrassing to say but I continue to see many therapists new to private practice repeat my mistakes in this area. I’ve decided to call it as I see it . . . namely that accepting anyone into a practice is fear-based behavior rather than being in the best interest of the client. Once you name it, it’s a lot easier to wrap your brain around it and begin to address it.
That’s great most of you have an established practice but what about those of us that are new? Everyone has to start somewhere and obviously there are clients who agree to meet with less experienced clinicians in exchange for a less hourly wage or a free consult and so forth. So how did you manage to survive as a new therapist in private practice without seeming desperate? How many phone consults does a therapist have to go through before actually getting a client?
Hi, Vaughn, and thank you for asking the questions!
Congrats on being a new therapist – it’s an exciting (and sometimes terrifying) time, isn’t it?!
Many times, it takes just one phone call to book that first client; sometimes it takes more.
The more common question that I get is “How do I get that first phone call?”
You make me wonder though if you have been more challenged in getting the phone to ring with prospective clients or if it has been a bigger challenge for you to get those callers booked.
Care to share?
Either way, when it comes to managing anxiety around booking clients, it has been most helpful to me in managing my own expectations.
Doing my research upfront by learning from successful-and-more-seasoned therapists’ experiences gave me a more realistic perspective than “learning” from therapists just like me who were “just getting started.”
The former were often eager to share “shortcuts” and their own learnings to help me get started while the latter (in spite of their often best intentions) often simply confirmed my worst-but-not-always-accurate fears and immersed me in their own anxieties.
Reality checks also helped to quell my anxiety during the early years of private practice, too –
– Learning to stand firmly in “what I know that I know that I know” including my faith,
– my beliefs in my purpose in life,
– my understanding in what I could and could not control,
– my admission (to myself) about what my strengths were not (and what I could do to address or compensate for those),
– leaning into my strengths / passions / interests,
– intentionally building my network of support to include joining or creating consultation groups.
Vaughn, stepping into a private practice is an act of faith for sure!
And, giving away your time, effort and energy in the form of “free initial sessions” can sometimes be an act of faith – just be sure that it’s not an act of desperation.
It’s a difference that can matter.
Hi Tamara, thank you for your response! I had a couple consult calls relatively recent which did not become clients. The second specifically would not schedule a first session time so I sent a follow up email offering a discount on her first session thinking maybe it was a financial issue. I have not heard back. It felt as if the prospect was looking for a free session because I said specifically the consult would be 15 minutes but the prospect kept continuing multiple times after I tried to wrap it up. Is offering discounts ever a good idea? Have you had clients seek after the consult and use it as a means for a free therapy session? What is the average number of consults before an actual client typically? Thank you so much for any input.
Hi, Vaughn! It’s great to meet you!
I want to encourage you to trust the prospecting that every client should engage in.
Clients who are prepared to engage in therapy will often “shop” for the right fit with the right therapist before settling on who to book an appointment with.
When I’m looking for a therapist, I look for what a lot of people are looking for – approachability, knowledge, experience, credentials, fees, training, theoretical orientation . . . but I’m also listening for the less obvious stuff like pacing (Is the therapist rushing me or not keeping up with me?), tone of voice (Is the therapist sounding focused on me, concerned, or clueless?), personal values, etc..
So, I wouldn’t assume I know why any initial consult didn’t convert into an appointment with me.
What I would be doing instead is polishing up my end of that initial phone call i.e. Was I clear in what I was offering? Did I explain what the client could expect from me? Did I give the client time and permission to express all of her concerns? Did I respond to each of those concerns to her satisfaction?
“Have I ever had a potential client push boundaries on a call?”
Absolutely!
“Is offering a discount ever a good idea?”
Does your doctor or attorney ever offer a discount?
I don’t think so.
“Have I had anyone seek free therapy sessions?”
I’ve had a few people try to negotiate a lower fee?
No, but even if they did, it’s not how I meet financial need . . . or their ambivalence.
“How many times does the typical caller call?”
Virtually every potential client that calls me only calls once.
If I do my job well – on that call, I’ve put them at ease, given them space to express themselves, given them all the information they needed to make the right decision for themselves, assessed the appropriateness of me working with them, and / or made any referrals that I might need to make or booked an appointment.
Vaughn, you may ultimately choose to answer some or all of these questions differently for your practice than I do for mine.
I will offer you two pieces of advice though related to fielding those initial calls . . . .
The first is to trust the prospecting process.
It’s important that not every caller choose you . . . or me.
We aren’t meant to work with everybody and there’s more than enough clients to go around.
And, the second thing I want to suggest you do is download the free script (at the top of this page) to help you finesse your initial consults.
You can do this!
I concur with all of the above! I offer a free phone consult to gauge the “fit” and that is usually around 20 minutes. It helps me gather info. regarding client needs (and how my schedule and expertise may fit those needs), and if insurance is going to be used. I do refer to other clinicians or practitioners if it is not a food fit – and I usually let the clinician know I have made a referral. It lets them know I value their work and it markets me within the networking community of therapists. I don’t actually get identifying information until the end of the call if we decide to make an initial appointment.
Yes, thanks for all of the input – it is a good question!
Best Wishes,
Vivian
Vivian – that’s such a smart thing to do – to let the professional know that you have made a referral to them! It’s an opportunity to show that you are a team player in your community.
Vivian, I can’t remember if I ever told you – you can get a little gravatar – an little image of you that pops up when you comment here and elsewhere. It’s really easy and helps us feel a little more connected to you.
Ditto! When I first opened my practice, I did offer a free 30 minute “consult” session to new clients. I had so many no-shows. I felt discouraged and like I had wasted my time. So I changed to a 20 minute phone consult and that worked really well! Most of them scheduled a session and came in! My no-show rate dropped significantly. Recently, my consults have moved to 10-15 minutes. I’m not sure why, but the rate of people scheduling afterwords has dropped. So maybe 20 minutes is the soft spot. Also, I’ve noticed that going on and getting people to schedule during that call, instead of emailing back to schedule works better, too!
Good morning, Tammy! I love that you actually notice that the reduced time is correlating to decreased bookings and that booking that first appointment while you are still on the phone works best for you. It’s attention to these little details that can make or break a private practice. Thanks for sharing your observations!
Hey, Tammy, I forgot to tell you – You can get a gravatar – a little image of you that pops up when you comment here or elsewhere. Here’s how to get your gravatar – the instructions are simple.
I do offer a free 30 minute consult for my clients. I am a fee for service therapist. In some ways I feel that when I am asking someone to pay a $100+ out of their own pocket for services the least I can do for them is offer a free 30 minute consult to assure that I am a good fit. Most of my clients contact me by email instead of telephone so the 30 minute consult tends to be more of a meet and greet in my office. I don’t go too much into presenting concerns during this time, besides what the first few sessions might be like. I try to assure that I have the battle for structure and steer clients away from clinical material that is better suited for the first session. I have found that most of these consults will become clients and it is actually very few that do not. I have not found myself becoming resentful when a consult chooses to not become a client. I like how you added that part in; as that would be a good indicator that you should not be doing the consult. Thanks for sharing this post!
Lyndsey, I so appreciate you dropping in to share a different experience with our community. One of the things that may make this work better for you (than it did for me and many others) is that you seem very focused on steering away from clinical material in that initial consult. That in itself is a skill that speaks volumes about your boundaries. Kudos to you!
I completely agree with all of what Lyndsey said here. I do the same – in-office consultations, roughly 15-25 minutes, no clinical information, and get a good return rate from clients. I’ve found that when clients want to meet me face-to-face, this usually helps them get over some of their initial anxiety to come back and begin work with me. I don’t get many no-shows and most people that do come in get a chance to hear how I see therapy, my methodologies, and what to expect from the process (basically a verbal Professional Disclosure Statement with some Informed Consent thrown in). So my consultations are more of learning about my business (which is me) than about an assessment, and usually I’ve already screened people out via email to see if their presenting issues are within the scope of my practice.
Great article, though, Tamara! I love that it made me think more critically about how I’m running my practice to see if I’m using my time and skills as wisely as I can! 🙂
Hi, Aaron! Welcome back! Thank you for joining the discussion here! So . . . I would pose the same question to you, Aaron, that I also posed to Catherine – When you are providing your professional disclosure statement and going through the informed consent process, my assumption is that you believe you are providing your free consultation. Is it possible that your clients do not see the difference (other than an exchange of money) between your consultation and your therapy?
And, I noticed that you are screening people via email so I’m also wondering how you encrypt your email. (Is that another guest post on encryption waiting to be written?)
Great question, Tamara. I hadn’t thought about it from that perspective, but I so appreciate it because clearly you have more experiences with attorneys and dangerous situations. My answer would be that I do clarify with people whether via email or over the phone (or frequently both) that it is a free consultation (no exchange of money), there is no intake paperwork completed, no commitment requirements from them, and that there will be no clinical information shared at the meeting (aside from what they’re looking for from therapy, such as tools for dealing with infidelity or coping with their panic attacks).
As far as email goes, I don’t really see it as screening. They contact me with information about their issues and why they want counseling, then I call to talk with them about it, and I may send an email confirming the date/time/nature of our consultation meeting. Screening happens over the phone, so no sensitive information is disclosed via email (and I try to keep it that way). My email is housed under Google’s Business division, I have settings that require two-step verification and always secure login, and include the confidentiality notice with every email I send. What are your thoughts about this – does it seem safe from your experience/perspective?
Ha ha! Aaron, I’m chuckling because I was hoping to pick your brain instead of you picking mine! When you stated ” . . . usually I’ve already screened people out via email to see if their presenting issues are within the scope of my practice” I thought that perhaps you encryption-savvy – something that I am not. I was hoping to learn from you. But, based on the above, I now understand that you are not sending your potential client’s personal information (including situation) back and forth via email so encryption is not – per HIPAA – a requirement.
I’m not at all familiar with Google’s Business division. I’ve never even heard of it. Perhaps another opportunity to learn from you?:) Is it, by chance, HIPAA compliant? Something other therapists might want to know about? What?! Is that yet another guest post waiting to be written?:)
It sounds like you are covering all your bases. So now I’m wondering if you (and others) actually document your face to face consultations in any way? I know that while I may jot down some notes during that initial phone call, I do not formally document my initial contact with clients until we commence with our first counseling session.
Good point. I do have encryption on my contact form on my website, so people can go into detail (and I let them know). When I respond they have to enter a pre-determined password to read it if I choose to encrypt the response. If they then respond to me and don’t use my contact form, I make it clear that it is not encrypted and that if they don’t use my contact form or get a free hushmail account, they may be at risk. I have this in my paperwork once they become clients as well. Even so, I really shy away from doing things over email because I do worry. And people get confused – I myself confused myself for months with it. When people send you messages through directories, that isn’t encrypted which is also confusing.
Just remember that clients aren’t obligated to comply with HIPAA when communicating electronically. We are.
I’m loving all of the comments on this blog post! It’s so great to hear so many different perspectives and ideas! Tamara, to answer your documentation question – ditto! I do not document anything from my face to face consultations until we commence with our first counseling session and then I only document that a free initial 20 minute consultation took place.
Thanks, Catherine!:)
Tamara, With regard to encrypted e-mail, I would recommend Hushmail. I haven’t used it much at this point because I haven’t started to see clients yet, but I’ve been impressed. There is an account that you can pay for (which I do because it’s not expensive and it means that I don’t have to worry about remembering to check it if there’s not any activity there) and there is a free account that anybody can sign up for. The catch is that you have to log in every two weeks in order for the account to continue working. One thing that I find really convenient is that you can set up Hushmail to e-mail another address to tell you that you have e-mail in your Hotmail account. This is very convenient. It does not include the sender, the subject, or any other information, just that there is a new message in the account.
Lauren Ostrowski! You are a dear! Thank you for sharing the info!
No problem. My informed consent goes into a lot of information about exchanging information over the Internet (because it will be a distance counseling practice), so I’d be happy to talk about the way that some of my informed consent is worded. It has not been looked at by a lawyer, but it does follow NBCC, CCE, and OTI guidelines.
That does go in quite a different direction than what we are here, so this may or may not be the best place for that conversation to continue, but I’ll leave that up to you.
Thanks, Lauren. I appreciate the offer and also appreciate you being cognizant of the need to keep this thread somewhat focused. It drives me crazy when the comments get too far off course:) So . . . feel free to pitch some ideas about possible guest posts about distance counseling. There’s definitely interest here. Or, if you prefer, look for some opportunities to share the info as it relates to past or future posts. And, I’ll keep an eye out for inquiries that may come in back channel, too.
Lauren, could you possibly share a copy of your informed consent for distance counseling? I’m trying to figure out how you can do this, Perhaps by an attachment. My email is Claudia.trevithick@gmail.com. Thanks so much. Claudia
Or, Lauren – a different way might be to consider writing a guest post on how an informed consent form for distance counseling might look!:) I’m sure there are others that might be interested, too!
Claudia,
I’d be happy to share my informed consent with you, provided you don’t use the entire document for your own informed consent. I’ll send it along later. Please keep in mind, I went through a training for distance counseling, and I would recommend that for anyone who wants to do distance counseling.
Oops, Claudia, I responded to you under Tamara’s comment accidentally. I guess I might as well switch them around. 🙂 Tamara, I will definitely consider doing a guest post and I will back channel you about a couple things before I start writing.
That would be great! Thank you for sharing your info!
Thanks, Tamara. Google’s business services are located here: http://www.google.com/apps/intl/en/business/smb/. They’re not targeted for mental health professionals, so you’d have to be extra cautious about how you set up your services to protect clients’ information (such as I described previously).
As far as documentation goes, I do not keep a record of those face-to-face consultations (other than in my calendar) because it’s not a clinical record; no clinical information was exchanged and no clinical services were provided, which I try to make clear to clients before/when they come in. So I definitely agree with you again on this one!
Thanks, Aaron! Hey! Why don’t you have a little gravatar with your image in it?! What’s up with that? Here’s how you can set one up for yourself. (It will then show up on lots of different websites when you comment.)
What, you mean like this? 🙂 I finally got around to doing it (thanks to your reminder)!
Hey! I can see your smiling face now! That makes me so HAPPY HAPPY! Now I feel like I’ll start to connect that name with that smile! Thanks, Aaron!
Tamara, I love this discussion. I am now contemplating the difference between a ‘consult’ and a therapy session. In Colorado, is this difference a legal one? Just because money may not change hands, therapy may happen. The potential client may still see the consult as therapy. (In Louisiana, at least, one can be sued for unwittingly and imprudently giving advice to a stranger in a grocery store. My next question is in response to your response to Aaron – what is an encrypted email and how does one do this? Thanks. Claudia
Good morning, Claudia! You are a wise gal to be asking the question. While there may be functional differences between a ‘consult’ to “see if someone is a good fit” and counseling or psychotherapy, the reality is that assessment, screening, and / or diagnosis is a part of counseling and psychotherapy. To that end, regardless of what a mental health professional chooses to call it . . . “screening,” “coaching,” “checking for a good fit,” or otherwise, it is my understanding that when a mental health professional is assessing or diagnosing an individual’s emotional / mental functioning, symptoms, and / or motivation to engage in psychotherapeutic work, this is the practice of mental health. That practice is regulated by the state in which the individual is physically in, may be construed to be counseling or psychotherapy, and that the practitioner – regardless of title – may be sued / held responsible for the activities that do and do not take place. It is, in part, why I choose to place a phone between me and that potential client at first contact.
Likewise, therapists making off the cuff remarks about individuals by throwing around diagnoses without formal assessments or statements like “She’s crazy” – comments that the general public can make with no consequences – can have significantly different consequences for mental health professionals. Twenty-four hours / day, seven days / week we are licensed mental health health professionals whose words carry a different weight and understanding. To carelessly make the comment that “She’s schizophrenic” or “He’s a narcissist” may not be seen as you simply voicing your frustration; instead, that comment may be viewed as a formal (and even unquestionable) diagnosis and pronouncement of an individual’s mental health and functional status. You’re right, Claudia, that all of this sloppy (and some would say arrogant) behavior and the imprudent advice given to a stranger can come back to haunt you.
I am not an attorney and would encourage anyone who is confused about this to seek the counsel of an attorney in their respective state.
And, because encryption is not my strong suit, I’ll be happy to leave your question about it up to Aaron to address!
Greetings!
Similar to Lyndsey, I also a charge for counseling and offer a 20-30 minute telephone consultation which works well for both myself and the client. The majority who do not schedule due so for financial reasons. I often suggest callers visit my website and sign up for the newsletter featuring brief articles about stepparenting and info about upcoming events and workshops. Clients have scheduled sessions after attending some of these events.
Dianne, I love that you suggest that callers check out your website and your newsletter to find additional resources that can support them. This is an excellent way to continue to build trust and good will until clients are ready to book appointments with you! Nice touch!
Hi,
Tamara, I really appreciate this post because I think it is a very relevant topic and important question. This very question is something that I reflected on for quite a while when beginning my private practice and I settled on offering a free 20 minute phone or in-person consult after trying a few different things. I love that I offer this free consult and it has worked well for me and my clients! Similar to Lyndsey, the format of my free consult is a meet and greet to determine therapeutic fit. It doesn’t always last 20 minutes, sometimes it’s less. I also, like Lyndsey, steer clients away from clinical material better suited for sessions and the free consult is fairly structured with just enough time to meet, share a little bit about myself and how I practice, answer questions the potential client may have for me, and get a brief idea of what the person is looking for in therapy. I am also very clear about the fact that the consult is not therapy, they are not a client, and I verbally go over the limits of confidentiality and inform them that I am a mandated reporter.
The main reason offering a free consult made sense for me and my practice was because I feel like it is a lot to ask of someone to come in and spend an hour answering questions, disclosing very personal information, and beginning to form a relationship if it turns out not to be a good fit for whatever reason. I feel like it is empowering for the person to be able to meet me, hear about my training and background, and make the active choice whether I am the right therapist for them and choose whether they want to become a client. At the same time, I am also screening and determining therapeutic fit on my end. The majority of the time I’ve met with someone for an initial consult, they’ve become a client and the few times that they haven’t – I knew it was in the person’s best interest and was able to offer appropriate referrals.
What I think is great about this conversation is we each have to know what is congruent for us as a person and professional. Tamara, you talked about “no strings attached” and for me that is how the free consultation feels. I like that there are no strings attached for the potential client – meaning they haven’t paid a fee or completed an intake upon first meeting me and therefore do not feel obligated to continue therapy even if it’s not a good fit. At least that is how it feels for me!
Hi, Catherine! I so appreciate you dropping in to share today especially because you are the first to say that you offer either / or! So . . . which one do your potential clients choose most often – the telephone or in-person consult?
Like Lyndsey, you seem to have clarity and boundaries around what happens during the consultation. I am interested in learning (from both you and Lyndsey) . . . do you have them actually complete your intake paperwork (as if they are actually a client) before / during your consultation? If not, do you have them complete different paperwork? And, can you say more about verbally “going over the limits of confidentiality” during your free consultation? It has been my understanding (from mental health attorneys) that while therapists may be very clear about consultations not being the same as therapy, clients are often unclear about those differences.
So happy to have this dialogue so that we can all have an opportunity to see the many ways therapists can choose to run their practices. I, too, recognize the need to find what is congruent for each of us as individuals.
(And, Catherine, it was so fun to finally meet you in person last week! Thanks for coming!)
Hi Tamara,
It was great to finally meet you in person as well and hear you speak about strategic networking!
To answer your questions, I find that the majority of my potential clients choose the in-person consultation if they want to complete an initial consult. Similar to what Kat said, I’ve found that if we’ve covered things during the first phone conversation that typically serves as the “initial consultation” and the potential client goes ahead and schedules a first session if it’s a good fit. In other words, I’m flexible and do not require that people meet with me in person for an initial consult. I’ve noticed that some people are comfortable spending some time on the phone and others are not and want to meet in person. I do not have potential clients fill out any paperwork prior to or during the initial consult. In terms of going over confidentiality, it is very quick and I inform them verbally of the exceptions to confidentiality. Your question got me thinking about the fact that I only routinely do this when I meet with someone in person and not when I’m talking with someone on the phone because the phone consults happen naturally and are less formal in nature (something I need to think about!). It hasn’t been my experience that potential clients confuse the in-person initial consult for therapy but that doesn’t mean it hasn’t happened, so I appreciate you bringing it up here and it is something to be aware of going forward. I think it would present a problem if they were viewing it as therapy and it’s something for me to think about! I am very clear about what the initial consult is and isn’t and hold tight boundaries around that framework. From a legal standpoint, we do not get into the “nitty gritty” as Kat put it and I don’t really see a difference between what many are describing that they do on the phone versus what I do if a potential client meets with me in-person for a brief consult. I believe there is liability no matter what modality a potential client contacts us through (phone, email, in-person) that all therapists need to be aware of so I’ll be curious to read what others have learned/heard about this topic! As always, your blog is a wealth of information and a catalyst for dialogue which I greatly appreciate! Thank you for doing what you do!
Hey, Catherine – You are right when you say that everything involves some degree of liability. When I referenced clients confusing a consult with a therapy appointment, I was really thinking about the client you work with for 6 months who then decides to sue you. And, as part of their treatment (in their minds) they reference that initial consultation (in your mind) appointment.
Tamara, thank you for introducing this topic. Having a free consultation has never really been on my radar. I personally take phone calls and try to limit them to no more than 10 minutes or so. I try to set the structure as far as what information is needed to “get started”.
It always surprises me how much one can learn about a potential client’s boundaries, listening skills and commitment in just l0 minutes. Many of my clients are coming through “word of mouth” so they already feel like they know a little about my practice through a friend or family member and then there are others who have read my profile on “Psychology Today” and lastly those who have been “recommended” by their insurance company or EAP.
First impressions are important and many people may choose a therapist based on initial comfort levels, but therapy is also about a relationship where trust is developed over time.
I should include this caveat though…I work in an underserved area and do not have to worry about competition at this point in time. If that were the case, I might feel the need to get more “creative” in my marketing endeavors.
Hi, Debera! Thanks so much for dropping in this evening to join the conversation. If your 10 minute limit is working well for both you and your clients and you already have enough clients in your private practice, then I wouldn’t change a thing. Your description of a quick 10 minute call is certainly how many therapists work – gathering the data that is typically gathered by a physician’s office and setting an initial appointment. And, I should add that in many offices that initial contact is made (and the information is gathered) by support staff rather than the clinician.
Having said that, should you find that you are not as busy as you would like to be seeing clients in your practice, this is an area that I would encourage you (and any other therapist in a similar situation) to reassess. By adding a few more minutes to that initial conversation, many therapists find that that time serves as additional trust-building “glue” that allows a potential client to feel more heard, understood, and connected to the clinician s/he is speaking with.
And, by the way . . . that trust that you talk about that is “developed over time” actually starts the first time they hear about your practice. That means they may have seen a blog you write, or your tweets, or your involvement in discussions on LinedIn, or a column you write in your local newspaper, or heard your practice discussed elsewhere. Each of those “touches” – long before they pick up the phone to speak with you / your office – have the potential to build to undermine trust in you as a professional. Trust typically begins long before that first contact.
Debera, just realized you don’t have a gravatar. If you would like a little image of you to pop up when you leave comments here or elsewhere, you can find out how right here. It’s simple and helps us start to feel a little more connected.
This is so interesting to see what different people do. I offer a free in-person or telephone consultation. If we are having a first phone conversation and we’ve covered things, then I call that the consultation. For couples and families I encourage in-person consults. Like Catherine, I’m clear that it’s not time to get into the nitty-gritty, but a time to learn about me and my general approach. I’m really taking that time to see if I have a potential client. Is this a couple that is dropping off one partner so that they can check therapy off of a list, or are they both invested? Are these parents who will be a good fit for me when I say I see children only in the context of family therapy, or are they hoping to attend a session or two and then drop off the kiddo? If I can’t get a parent’s buy-in to being involved in therapy, it’s best that they not become my client. I’m also using that time to be very clear about what they can and cannot expect from therapy. I’m interested in working with people that want to be proactive and do the work between sessions, not someone who is interested in me fixing them or becoming reliant. It takes time to develop that, but if someone bristles at the thought that my focus is on them learning to help themselves, then they might be better served by a different therapist. People generally leave my office with a new perspective on what counseling can do for them, and a motivation to become great clients. If they don’t, then neither of us feels a loss at not working together. I remember triumphantly telling a colleague that I had a great consultation and didn’t feel like I was selling my services at all. It was a very grounded and empowering place to be, and a place that I try to stay in. It does require some clear boundaries around keeping it to “a chat about what working together would look like” and not letting it turn into therapy. I’ve gotten referrals from folks who chose not to work with me, funny enough, so I think that you never know what kind of connection you have made until you see it come full circle (even years later sometimes).
HI, Kat! Thanks so much for dropping in tonight to share your thinking about this. So the piece of this discussion that is most of interest to me is that we all obviously are doing our screenings / consultations in much the same way – assessing for fit, explaining the benefits, challenges, and process of therapy, setting expectations, etc. Where we differ is in the choice to do that in person and or by phone or email. I wonder if you (and others what are reading this thread) can speak specifically to your thinking related to that particular choice so that others who are just starting our or reassessing their practices, can take your experiences / thoughts into consideration.
Sure! I guess for myself, I just like to meet people in person. I think we get a feel for each other’s personalities and comfort. I love being able to help someone feel comfortable reaching out to a therapist. They shake my hand and appreciate, truly, what my time has meant to them. Whether they ever come in, I think to myself that this person has made a step to actually get in their car and see a counselor. It may increase the likelihood that they’ll put that effort in to actually seeking therapy. And I have never seen it hurt to make a real impression on anyone. I will add that I’m picky about the times I offer for consultations – I always try to put them at times that I have other clients nearby and it won’t represent a big investment of scheduling or inconvenience for me.
I think the piece that is reinforcing for me is what I get out of the face to face contact. I’m also assessing them and whether they are looking for what I’m offering. Eye contact, body language, engagement, these things are not things that I can assess over the phone. I can tell if someone is cringing when I say that 90% of their success will come from what they do outside of our session times. So I have referred clients that I don’t think will gel with my style (and known better who to suggest to them), and that’s not something I think I could do as well from just phone contact. From the first moment of contact, I believe that I am shaping and influencing helping that person get unstuck- even just in the way that I ask them to tell me what they are looking for without getting mired in the details. That itself is an intervention, so even though we aren’t doing therapy this face to face time is therapeutic and very indicative of what we will feel like working together. Ten or fifteen years from now I may not have this in place but it definitely works well for me. It’s also relaxing to have a chat with someone who is feeling optimistic about therapy on those days that everyone seems stuck! 🙂
Kat, this is really a lovely expression of who you are as a person and as a clinician. I know your clients must feel that connection with you from their very first contact. Thank you for taking time to share such a thoughtful response! It gives all of us time to reflect on our own intake processes.
Kat, I second Tamara’s thank you for your thoughtful response and agree that it is a an expression of who you are as a person and clinician! You are an inspiration and role model for me and I appreciate your willingness to share about your process!
For me, the simple truth is I just prefer face to face interactions for numerous reasons, many of which Kat outlined above. I am not a phone person and never have been. In fact, I worked for over a year at Denver Health providing telephonic counseling as part of a depression research study and, although I learned a tremendous amount about assessing and providing services over the phone, it validated and reinforced my preference for face to face contact. I found that I was drained after even a 30 minute phone session whereas I feel energized when I meet with someone in person. I also think in our society today face to face contact free of distractions is rare and therapeutic in and of itself and something I can offer to my potential clients. It definitely does seem like we are all essentially doing the same thing whether via phone, email, or in-person and I think how we decide to do that comes back to how we function personally and professionally.
I so agree with you, Catherine! Face to face is always energizing for me and the distractions that come with phone calls are frustrating at best!
I third Tamara’s agreement about preferring face to face and your thank you to Kat about the thoughtful response! This is such a great topic with so many great differing perspectives and voices on it!
Hey, Aaron – I want to be clear. Although I prefer to spend time with clients / colleagues face to face rather than over the phone; I prefer to offer my initial consultation by phone:)
Thank you both for your kind words! I hear so much of what I’ve learned from my trusted consultants there – learning how to leverage your time and not fall into that powerless, pandering, fear based thinking, but to be empowered as a clinician to create the therapeutic interaction from the moment a person steps into your office. Having these discussions helps us all develop our solid approach to everything we do. I love this stuff!
And Catherine I’m also totally drained on the phone. I notice that I put my face in my hands, hunch over to talk, and generally have the complete opposite going on with my affect that I would in person! And Catherine I look up to you for many reasons as well, it’s just a love fest! 🙂
Thank you, everyone, for this lively discussion! I’m so glad that my question was useful for others. I am newly licensed and building my practice, and I find that I follow people’s lead about contact- some contact me via email and are ready to meet with me because of a recommendation, some want to ask questions. I’m now thinking through what it would mean for my practice if I took 15-20 minutes to talk to each and every person. I wonder what that would be like for those clients who are not as comfortable on the phone.
I have a part-time practice, and I teach and supervise as well. It would be challenging to offer face-to-face consultations since I am not in the office every day, but I thank all of you who shared how you do this. I will look back if I decide these consultations will help!
Thank you, Tamara, for creating and facilitating this space for learning and sharing ideas!
LeLaina! Congrats to you on getting licensed as a psychologist! And, thanks for dropping back in here to follow up and let us know how this discussion is influencing your thoughts, too. I hope you will drop back in often to join the conversations as you continue to build your practice!
LeLaina, here’s instructions for how you can set up a gravatar so that a little image of you shows up when you comment here and elsewhere. It helps us all network and get to know each other better.
Thanks for the tip! It’s nice to “see” everyone here. I have always been skeptical of the depth of community that can be built online, but I’m finding after only a month or so that this place is quite vibrant and supportive!
LeLaina! Fancy “seeing” you here! Lovely! Now Boston . . . or is it Jamaica Plain? isn’t seeming so far away!
I know exactly what you mean! When I started (grudgingly) blogging back in 2009, I thought of all this social media / tech stuff as “cold,” “impersonal,” and “scary.” But, today, I know that I’ve met some of my favorite therapists (ever) right here; I’ve stumbled into amazingly supportive communities; and, truthfully . . . if I go too long without talking to you guys, I miss you even though I’ve only met a few of you face-to-face. And, then there’s others, like you, whom I’ve only met briefly once while traveling to a conference or on vacation or when I was taking some of my consulting work on the road.
I’m the proof (and very grateful) that you can teach an old dog! You guys are part of my extended family and I’m grateful to count you, LeLaina, among them! I look forward to finding your voice here in the coming weeks! Let us know if you need any support along the way. I won’t have all of the answers but, as you can see from the conversations that occur here, I’m sure someone will! Have a great weekend!
LeLaina, I remember when I first found Private Practice from the Inside Out. I was amazed about how positive and supportive environment was. It’s a far cry from some other mailing lists and listserves, and I always find myself here when I want to interact with people who are not always complaining about what isn’t working. While we do a fair amount of talking about what doesn’t work, there are always positive opinions and ideas that come out of it, so it is worthwhile and productive discussion. Sounds like you have noticed something similar.
🙂 Sometimes it pays to change who you are hanging out with! I learned years ago that if I hang out with whiners, I am likely to start whining and when I hang out with cheerleaders, I learn a few cheers, too. We all have our challenges related to our businesses. Learning to identify what we need to learn or do different is part of the journey. Asking for help is part of the journey. Follow through is part of the journey. Complaining is not on the journey to building a strong and vibrant practice – at least it never works well for me.
Happy to have you guys on my journey and to join you on yours, too!
I enjoy giving a free phone consultation. If people come to my office for an initial visit I want to be pretty sure that we are a good fit and will work well together. I want to honor how difficult it is to take those first steps toward getting help. I only offered a free office visit consultation once when I first opened my practice. At that time I decided to never do it again because of all the reasons listed in this post. When I had my potential client in my office during our free consultation it felt like neither of us knew what the “rules” were. I didn’t want to open anything up in case we didn’t continue a relationship and therefore was less than my authentic self in my role as a psychologist. It just didn’t feel good.
Hey, Steffanie! I so appreciate your voice on this topic. I’m curious . . . . Do you differentiate between the initial phone contact that you have with your potential client and that of your phone consultation?
No, I don’t. I post on my website that I offer a free 20 minute phone consultation and when I first talk with potential clients I ask then if they have a couple of minutes to talk so that I can get an understanding of their needs and answer any questions they may have about me or my practice. After this phone conversation/consultation I offer to work with them if it seems like a good fit. If it doesn’t seem like I can meet their needs I try to give them some names of others who might be able to serve them.
Got it, Steffanie. I do the same thing. The reason I ask is that I’ve heard different therapists use different language to describe this initial call – some, like you, refer to it as a “consultation,” others refer to it as a “screening,” and I’ve heard other refer to it nothing more than the “initial call.”
I offer potential clients a free 15 min phone consultation, and its been working pretty well for me in my practice.It gives me an opportunity to do several things: find out about their concerns, screen clients to ensure their issue is within my scope of practice, answer client questions about my services, and figure out if its a good client-therapist “fit.” However, if a client really wanted to meet with me in-person for a consultation I would be more than willing to do so. Every clinician is different and I understand that for some people phone consultations don’t work for them and in-person consults are better.
Yep! It’s definitely different strokes for different folks!
I really enjoyed reading through this discussion, I know it was opened long time ago but just wanted to say thanks and leave a comment.
Here in Mexico, offering a free consultation is not a common practice. I actually considered doing it, but i didn’t feel 100% comfortable with it.
I am also a speaker, so I offer a short free weekly conference at my office every Wednesday evening for the general public. The groups are small and limited (5 to 12 attendees) I really enjoy doing this and I usually invite my potential clients to attend the conference. We have then the opportunity of a very quick interview at the end of the conference where i can answer their questions and they already had the opportunity to know something about me during the conference.
So, I do offer one hour of my time for free every Wednesday, it gives me the opportunity to test new conference material and give my potential clients the opportunity to know about my practice. I decided not to offer free consultation for all the reason you have shared before.
Thanks
Hi, Cynthia! Welcome to Private Practice from the Inside Out and thank YOU for joining the conversation! As the field of mental health continues to admit new practitioners, I think it’s helpful to keep the commenting open and accessible to all. I’m glad you agree.
You said that you “didn’t feel 100% comfortable” offering a free consultation. I’ve shared some of my concerns about it, so I wonder if you might talk a little bit about your own concerns.
I love that you offer your time by inviting the community in to meet you via your speaking! That’s such a great idea! It builds familiarity as well as your own credibility and it also chips away at the “scariness” of going to a therapist’s office! Great way to connect with prospective clients and referral sources, too!
I completely agree with this and why I’m so torn right now! Given the current situation we are all dealing with regarding COVID-19, I’ve been tempted to provide a free but limited support group via online to help with the anxiety and fear from all this. You’ve given me a lot to consider, thank you!
Thanks for saying this, Jacqueline!
Before you make that final decision, I would ask you to be completely honest with yourself about your reasons for wanting to offer this free service.
If it’s about your fears – of not having enough income, not having enough business, etc., then that’s NOT a good reason to offer them.
If, on the other hand, you want to consider this as part of your charitable or community services . . . Or you want to consider this as a marketing effort to build your professional reputation . . . Those can all be great reasons.
The caveat is that when therapists do this type of thing out of their own fears and anxieties – even if the other motivators are also true – they will inevitably resent their commitments and / or clients down the road who “pay too little,” are “too needy or demanding,” or are otherwise no longer fulfilling to work with.
Working with our clients may be mutually beneficial but our primary focus must be on meeting our clients’ needs.
And, as stated in this article, “free” services – regardless of our motivation – may be perceived as less than by potential referral sources, colleagues, and potential / active clients.
I offered a free consult when I first opened up 10+ years ago. However, I felt more like a sales person then a therapist. I also had ethical issues regarding discussing therapeutic issues without a consent as required by my license. I felt that people were just looking for a quick answer and therapy. The most famous question is “Can you help me?” I don’t think you can judge that in a 5-10 minute conversation. I also had people that were just wasting my time and “testing the water” so to speak and never scheduled. I have a full practice that accepts insurance, so I feel that wanting a free consult is devaluing my time and worth even more- as you said that is how we make a living!!! People are also good at hiding things over the phone. You really don’t know if someone is a good fit until 2-3 sessions in. We want to be taken seriously as medical professionals. Have you ever asked an OBGYN, ENT, or other medical professional for a free consultation? So why do we allow ourselves to be different from the rest of the medical community.
I also found that it can set poor boundaries. I get a lot of “I just want to chat and see if we are a good fit.” I think people think of your more as a friend at that point and less of a medical professional. Once those boundaries are blurred, they are very difficult to put back. I am lucky to have an awesome practice manager that screens calls and if it is something out of the ordinary, will ask me first. She won’t just give me clients to fill my calendar but tries to make a good match. There are way too many ethical issues that end up creeping up when you talk directly to a client without signed informed consent and dangers and limitations of therapy.
“. . . it can set poor boundaries” and “Once those boundaries are blurred, they are very difficult to put back.”
Yes and yes.
It’s such a perk to be able to have a practice manager to screen for you but I feel like it’s important to also say that every clinician should develop the skills of setting boundaries and making initial assessments AND be aware of the ethical issues that can show up when we don’t develop those assessment and boundary-setting skills!
Thank you, Jackie, for taking the time to join the conversation today!
I hope you’ll be back often to chat with us!
Thanks, Jackie, for dropping in and taking the time to respond so thoughtfully to this post! You said several things that really resonate with me –
“I don’t think you can judge that in a 5-10 minute conversation.” That’s such an important piece to consider! No professional I know makes a clinical assessment in 5-10 minutes!
“. . . wanting a free consult is devaluing my time . . . ” yes AND feeling like we “need” to provide one is US devaluing our time!
And, finally, “Have you ever asked an OBGYN, ENT, or other medical professional for a free consultation? So why do we allow ourselves to be different from the rest of the medical community.” – such a great point.
There are plenty of reasons to make our services available to clients with financial needs – but this is not the way.
I am a newly licensed MFT as of this year and I never offered a free in person consult session. I have always conducted a 15-20 minute phone session which allows me to get to know the potential client and them to get to know me. Maybe its my background in sells but many client’s have stated that it was the initial time I took with them over the phone that solidified the deal. I placed value on my time and my skills learned through my education from the beginning. I had to fight the urge of “I need this client” especially to get the hours and trust in my process. I started right out of grad school in private practice. I also do not take insurance and have a thriving practice.
Hi, Sam! Thank you for dropping in and sharing your story.
It is similar to my own.
I have only spent time with an initial caller on the phone and it was enough – enough for me to appropriately screen the clients and enough for them to get a “feel” for the way I work and choose to make an appointment.
I do believe that those who choose to offer “free consultations” often come across to potential clients as feeling desperate and unsure – two things that often repel some clients and in other cases attract the wrong clients to a therapist.
I see your story and mine replicated over and over again.
I appreciate you encouraging others here to lean into their professionalism and trust that the right clients will come.
I offer a free phone consultation and find it’s really helpful for clients to understand the process. They ask questions to help them feel at ease with me about moving forward.
Do you offer any forms for clients to sign stating this is not therapy?
Thanks.
Hi, Cheryl! This process that you describe is what all therapist should be doing – educating about the process and assessing for appropriateness of fit, too.
I do not have a form for this initial contact.
Instead, I scribble notes for my own benefit, toss them in a folder and refer to them to refresh my memory prior to that first appointment that is scheduled.
While this is definitely “not therapy,” it is important to know that that initial contact (whether an appointment is made or not), is considered to be “Protected Health Information” and is covered by HIPAA.
Thank you for asking this question!