Is Referring Clients Out the Key to a Sustainable Practice?
What is the most important element in determining whether or not your practice will be sustainable? Recently I’m starting to think it’s your process for managing new client inquiries! Over the past few months I have been tweaking my own screening process for new therapy clients and getting even more clear on who is a good fit and what is sustainable for me. In a nutshell, I know that I work best with anxious HSPs committed to weekly depth therapy who are appropriate for telehealth. When I deviate from those parameters, as I did a few times over the past few years, I become depleted and honestly - don’t want to be a therapist!
The Importance of the First Call
Initial contact with clients can seem so insignificant compared to the therapy itself since you usually only have one email exchange and a short 15-20 minute phone call before diving in, but this process is a critical part of maintaining a sustainable practice. It deserves more attention and preparation. I’m sad to say it, but sensitive therapists often drop the ball here and create a lot of work for themselves down the line. In the past, I’ve been guilty of this too!
Being more empathetic is a huge gift as a therapist, but it can lead you to ignore your intuition, set your own interests aside, and compromise your boundaries. You probably have taken clients into your practice even though they:
were outside your specialty
needed you to lower your fee
wanted a timeslot outside your preferred schedule
something felt “off” during the consult call
Is Guilt Clouding Your Instincts?
Guilt, a byproduct of empathy for HSPs, can really cloud your ability to honor your needs and instincts when making decisions for your practice. Bending to take on even one client that’s not a good fit for whatever reason is detrimental and a clear path to burnout. Allow me to share a personal story.
As an associate MFT in California, I was required to work with couples, families, and/or children for a portion of my 3,000 hours to satisfy my licensure requirements. There was one couple I started working with during this period that I took on despite my intuition saying they needed to be referred to another resource. Admittedly, I was blinded by my need for couples hours and they proved to be a very difficult case for me.
During the few months we worked together, I devoted so many hours preparing for sessions and managing the emotional exhaustion that I stopped doing progress notes altogether - for ALL of my clients! As you can imagine, not doing notes for several months created a huge backlog and added additional stress that I dealt with long after I stopped working with this one couple. Not only that but I’m sure my other clients were impacted, certainly receiving less of my therapeutic energy. Eventually I referred this couple out for individual support, which needed to be done in the first place, but the damage was done! I was exhausted and buried under hundreds of undone notes.
This is the most extreme example but there were certainly other cases where I should have referred out but either felt too guilty, doubted my gut instincts, or worried about how the client would feel being turned away. What I have realized is that avoiding a somewhat difficult conversation early on is much easier than needing to refer a client out down the line once a therapeutic relationship has been established. Although you feel bad, referring out can be the most compassionate and clinically appropriate choice.
The Impact of Just One Wrong-Fit Client
Working with someone who is not a good fit clinically or logistically leaves you working outside of your boundaries and is extremely draining. Perhaps you have a client who is way beyond your area of clinical expertise so you need to devote additional hours to researching and consulting, like I did with that couple years ago. This may be a clinical issue that you don’t have interest in or have the time to invest in. For one client, you are sacrificing time that could be used for writing notes, deepening your clinical skills/interests that could apply to many clients, practicing self-care, or connecting with loved ones. This one client ends up taking up the same amount of time and energy as multiple clients, impacting your ability to help more people and earn more income!
Don’t Work With Everyone
Of course, there’s the argument that we should be well-rounded and not turn any clients away. I must say, I disagree! While you may feel stifled with just one niche, jumping to the other extreme to become a broad generalist may also not work as an HSP. Trying to “do it all” will leave you feeling overwhelmed and empty. Instead, consider having several areas of specialization to create space for depth, meaning, and fulfillment in your work. This also allows your clients to experience the powerful impact of being deeply known and understood, rather than getting a watered down approach. I can’t tell you how many HSP clients have reached out to me with excitement and relief, saying how much my website and blogs really spoke to them and they finally felt understood.
Screening clients is obviously multi-layered and very complex since it requires you to assess not only their availability and financial situation but also their presenting concerns/clinical fit in only a short time. That’s why being an HSP with heightened perception and a strong intuition is a huge asset! Your brain and nervous system are working behind the scenes to assess the nuances and unspoken details of the interaction. If something is “off”, your gut will let you know. Get quiet and listen to it!
There will be times when it’s clear why the client is NOT a good fit and you can communicate that directly:
They need an appointment time outside of your availability
You don’t take their insurance
It’s apparent they need a higher level of care
Your sliding scale spots are full and they currently can’t afford your full fee
They’re looking for a specific approach you don’t offer like CBT or EMDR
The client is outside of the state where you’re licensed
You don’t work with the clinical issue they are presenting with
And then there will be times where the reason for referring out is vague and/or difficult to say. Maybe there’s something about the client’s personality, values, or communication style that you know won’t be a good match, but of course it would be harmful to communicate that directly to the client. Perhaps you work with couples or complex trauma as part of your practice, but are at your personal max for these types of cases. Maybe you don’t know why, but your gut is screaming “no” to working with this client.
Honoring the Client’s Needs Too
Whatever the reason, taking on a client when you need to refer out is a straight road to overwhelm, resentment, and eventually burnout. Instead lead with honoring the client’s needs and gently let them know that based on your experience you can see a different path is best. Provide referrals. This might sound like:
“Thank you so much for sharing what you’re needing support with at this time. You’re definitely not alone in feeling this way. Although I wouldn’t be the best support/don’t specialize in _____, I would be happy to provide you referrals for someone who would be a better fit. Do you have a pen? or What’s the best email to use?”
Turning clients away is difficult, I know, and it’s also essential in being able to best support the clients you do have while keeping yourself fulfilled as a clinician (and human). I encourage you to take some time to reflect on your non-negotiables when screening prospective clients. What clients and presenting concerns are the best match for your personality, therapeutic style, and availability? What gets in the way of trusting your gut? What’s the impact on you and your practice when you bypass your boundaries and ignore your gut instincts during client screenings?
For More Support
To ensure incoming clients are the best fit and not taking more energy than you have to give, watch my free workshop: 3 Pillars of a Sustainable Practice. It includes a workbook with sample schedules and screening guide for new client inquiries. Sign up here to watch the workshop and download the workbook.
