Texas Counselors Creating Badass Businesses

102 How to Avoid Common Mistakes in Your Therapy Intake Session

• Dr. Kate Walker Ph.D., LPC/LMFT Supervisor • Season 3 • Episode 102

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Can a simple change in your personal presentation drastically improve your client retention rates? Discover the vital link between reducing client anxiety and enhancing your intake process as Dr. Kate Walker breaks down the most common mistakes therapists make during client intake. From the critical role of good hygiene and a well-organized virtual setup to presenting a calm and welcoming presence, this episode covers essential strategies for creating an environment where clients feel comfortable and eager to return.

Authenticity and preparation are key to a successful practice, and this episode offers practical solutions to logistical challenges such as parking and navigation, as well as insight into ensuring your online presence accurately reflects your therapeutic approach. Hear about the importance of setting clear expectations from the start through a story of a neighbor's unsatisfactory play therapy experience. By balancing clinical acumen with effective marketing techniques, you'll learn how to streamline your intake processes and authentically showcase the therapeutic experience you offer. Tune in and take your client intake procedures to the next level!

Get your step by step guide to private practice. Because you are too important to lose to not knowing the rules, going broke, burning out, and giving up. #counselorsdontquit.

Speaker 1:

Hey, I'm Dr Kate Walker. Welcome to your Tuesday coaching. Come on camera. You got to stay in focus for me, all right.

Speaker 1:

Today's kind of an interesting topic because it takes me back to my counselor educator days, right? So this is sort of like okay, I was getting my notes together and I'm thinking, well, I want to give them the counselor educator perspective, but you know, this is a group for business too, so I want to make sure you get this from a marketing perspective, and so I literally I'm making my notes and I have terrible handwriting, but I wrote a line down the middle, right, and so on one side I put clinical, on the other side I put marketing, and so common intake mistakes. I want to make sure that you get what you need from both perspectives, because that's the cool thing about the Step it Up membership and Kate Walker training and Texas counselors creating badass businesses. I know I've got folks listening to this who are maybe still in grad school. I know I've got folks listening to this who are seasoned practitioners and, of course, then supervisors, who are in the unique position of not just having to practice the skill. They've got to assess the skill in someone else and then teach the skill if the person they're assessing doesn't know what they're doing, and remediate it and all the things. So I want to make sure I make it very, very clear this one concept, all right, and if you have heard me before, you've heard me say this a million times I want you to just kind of clear your mind in through the nose, out through the mouth.

Speaker 1:

When anxiety goes up, cognition goes down. Okay, everybody got that. We know that. That's fight or flight, freeze or fawn, all of the things that have to do with our beautiful autonomic nervous system, right? So we have these things that are designed to keep us alive, these responses. They respond, you know, due to visual triggers, auditory triggers, you know, olfactory triggers, all of these things. We're constantly sensing the world around us to decide if it's safe or not. Now, brain is a beautiful thing, and when that autonomic nervous system is triggered, what happens? Well, our cognition shuts down. That doesn't mean we stop thinking. What it means is we immediately have to make snap decisions, right? So we have to make decisions quickly. We're not like hey, let's look at a map and figure out what we're going to do. If I'm a pilot in a cockpit, I'm not going. Let's go over the schematics If it's like no, no, no, just pull the lever right. So your brain, when it is in a state of fight, flight, freeze, fall and all the things, is not able to do a really high level discernment, decision making, all the things. So everybody got that when anxiety goes up, cognition goes down. All right, I shall begin.

Speaker 1:

So for the first part, clinical, I will take it from personal presentation. Intake mistake number one personal presentation. Now, of course I had to do this from just in a face-to-face, setting things like basic hygiene right, okay, Error, big error. If we are stinky, right, or if we are wearing a perfume that is displeasing or really really strong, or we don't believe in deodorant, right, you get to do you I'm talking to you, mental health provider but it can be a mistake if those things about us trigger you see where I'm going here fight, flight, freeze, fawn in our client, because then their anxiety, which is already super high because they're meeting you for the first time, kicks in even higher and they're not listening to you, they're not able to process and do all the things we want them to do, even if it's just an intake assessment. So, things like hygiene, we teach new counselors SOLAR, which is just an acronym for how they sit. They're leaning forward, they're making eye contact. If you are virtual, that personal presentation becomes your background. Right, you're framing how you're framing yourself in the picture.

Speaker 1:

I did therapy with someone for a while and this is basically what I saw most of the time. I'm exaggerating here, but I really just saw the top of her head most of the time and it wasating here, but I really just saw the top of her head most of the time and it was very distracting and I found it very hard to really do therapy because I was so worried about where's the rest of her head. So your internet quality, right, if there is a lot of cutting in, cutting out Long and short when it comes to personal presentation. I'm talking as a counselor, educator here and I'm talking to you. You have one job in that first session usually and I'm going to get into more detail about that that is to get through your assessment and to get through that intake paperwork and you need your client to be in a state where they are receptive.

Speaker 1:

Now, we are taught our entire lives. You can't make somebody feel a certain way, yeah, and it is your job to be the least anxious presence in the room, because the mirroring neurons and all the things we know about how a therapist, when they are able to regulate how they sit, where they put their hands, how fast they talk, they are setting that environment up in the room for their client for their anxiety to come down and then they can start doing the work. Remember, these are intake mistakes. These are not theories. I'm not teaching interventions in order to help your client achieve their therapeutic goals. These are intake mistakes that can really negatively impact whether or not that new client is going to come back. I mean, you guys spent all summer working on your boot camp stuff, your KPIs, getting those phone calls up, making sure you weren't playing phone tag, getting folks to actually make the appointment, show up to the appointment. You did it, you got them. These are things that you can fix quickly. Bottom. These are things that you can fix quickly Now I'm going to now go to the marketing aspect.

Speaker 1:

All right, see what I'm doing here. Clinical aspect, things like hygiene, things like how you sit, things like your framing, your internet quality those are, you know, some of the things are in your control, some of them aren't. Now I want you to think from marketing, right? One of the things if you have gone through the trainings in your profile or you've gone through videos and podcast episodes, one of the things we talk about a lot is an ideal client, right? Remember, I'm not talking clinically anymore. I'm talking about, from a marketing standpoint, who is the person you are trying to improve their sports performance. I want you to go to a bunch of sporty websites and see what their color schemes are, see what their fonts are, see the type of verbiage that they use, the images they use. Right, because you are trying to portray right that's on the giving side yourself as someone who is knowledgeable about sports and performance. What you're wanting to be received right, that's what you're wanting.

Speaker 1:

Your potential client now actual client, sitting in front of you what you want to be perceived is your expertise in the area that you say you're an expert in, simple right. Well, this is where we can get it wrong, because if you've done a lot of work and you have portrayed yourself as an expert in a particular area in order to attract a particular client and they show up and you don't know what you're talking about, that's a problem. Or, let's say, you're trying to portray yourself as someone who is an expert Well, I keep going back to the term expert because that will inform your website copy, that's going to inform your blog posts, your Instagram posts, your TikToks, all the things that you're doing, posts, your TikToks, all the things that you're doing and they show up and you don't look like that, or you don't act like that, or you don't use those words, or you don't have that parameter that you say you have. I'll use myself as an example. One of the things I marketed myself as was I don't do this anymore because I don't live in Houston anymore I marketed myself to couples who were experiencing difficulty due to working shift work with the oil industry, right, super niche-y, super specific. But I had to inform myself, I had to attend training, I had to really do my homework to understand the impact of shift work on circadian rhythms, to understand the impact of shift work on the family dynamic. What were the highs, what were the lows? Right, if someone had shown up into my office and I was like what's shift work? What are circadian rhythms? What do you mean? On two off four or on four off two? So what you are putting yourself out as one of the biggest mistakes you can make is not being that person when that person logs onto your website I'm sorry, logs onto your call or shows up in your office when in doubt.

Speaker 1:

Here's the second thing I want you to remember from this Ask a friend, Ask a friend who could be totally honest with you to read your website copy, read your posts, watch your TikToks, look at your Instagram and then look at you, how you would present on a work day, and ask them say, okay, do I look like who I say I'm going to look like, do I talk like how I say I'm going to talk? Do I know the facts, the things that I portray, that I know on my public facing copy, and that friend, if they love you, they will sit down and say, okay, look, here's where I think you're on track, but here's where I think you're off track. And ask two or three friends who love you and who would be honest with you so that you can get this on track. Remember, if you're listening to this, in September, september and January, those are our biggest months. I mean, that's why we spent all summer in the boot camp, so we could get ready for this fall rush between now and when folks start getting ready for some national and religious holidays in about eight weeks. Right, this is the sweet spot when a lot of families go okay, we've got to get in. It's now or never, and then it can happen again in January. So we are prepared, right, right, okay, next thing critical, pretty critical intake mistake for office people, those of you who have a face-to-face office, two things you're hard to find and there's no parking.

Speaker 1:

I know you got a great deal on that office. I know that it was just. You know your view is amazing. But if your client shows up and they're already mad because there was no parking and they are already frustrated because they took a left when they should have taken a right, yes, yes, I know you gave excellent directions, but remember anxiety up. Yeah, these folks who have finally taken the step to come and see you, right, this may be their first time in therapy ever and they take a deep breath, they get out of their car and they don't know which door to go in. Right, you have to, as a business owner, as a clinician, think like that client. Right, again, I'll tell stories on myself.

Speaker 1:

I worked in an office with two major problems, right? Problem number one we were right next to a movie theater, right. So the popcorn smell at lunchtime was incredible. But you can imagine what happened on Senior Discount Monday, right, my parking lot was full and folks coming in who were already angry or sad or anxious. Guess what I got an earful of as we were walking down the hallway to my office, right? So, yeah, theoretically I could turn that whole thing around and say, oh, this is lovely. My couple is letting me know how they are, right. But I mean, this is their first time right, and we want them. Anxiety down, cognition up, so we do what we can.

Speaker 1:

Second problem my office had was they closed at five. Secretary went home, so I had to scotch tape a sign on my door the big door like the door to the lobby that said hey, if you're here to see Dr Walker, you are in the right place, smiley face. If you're here to see Dr Walker, you are in the right place, smiley face, hang on, I will be out as soon as my client before you is finished. We had a back door. I could send my client out one way and then walk to the front, invite the new client in. But I let them know hey, you're in the right place, you're doing a great thing. Don't worry, take a breath, I will be there when we go for.

Speaker 1:

So that's actually the clinical aspect From a marketing standpoint. Solve it for them. Solve this problem, for if you know parking is difficult, put it on your website, say, hey, look, here's where you park, here's a map. And then, if you're allowed to, I would even put signs along the way, put QR codes along the way, something to help them understand. Hey, you did it. You made it, You're in the right spot, You're on time. It's okay. Everything's going to begin in a minute. All, right back to to clinical.

Speaker 1:

Let's talk about assessment. You know the assessment, right, the assessment is that first session process we go through to develop a treatment plan. If you develop a diagnosis, everything that's going to inform what we do in session two and beyond. Right, I want to know honestly. I want you to think, be honest with yourself. Are you using an assessment that you love, or have you Frankensteined something together from grad school and your friends and this training you went to in 2015. All right, I want you to think about that assessment and what information do you really need from it?

Speaker 1:

Some of you are still using the assessments we gave you in graduate school that would take two days to finish, right, because we printed it out of your textbook and it was 85 pages long and it was asking information that still didn't even have the word internet in it. You know? I mean, really, how long has it been since you've looked at your assessment? I know with my couples eventually I got to a place where I could take a 10-page assessment that, yes, I had Frankenstein together from grad school, a training, I did a job that I had and I was able to pare it down to about three pages that matched my theory. So I am a strategic family therapist, I do. I'm structural as well, so I guess I'm pretty eclectic. So I know the information I need to get. I know what I'm headed for in that first session.

Speaker 1:

So that may be hard for you new counselors, if you're still in grad school or you're newly practicing an associate in private practice or even at your agency, but for you seasoned folks, I bet you you could take a pair of scissors and cut your assessment down to almost nothing. So this is a clinical standpoint. I want you to think about what you're really trying to get from that assessment and if you still insist. Well, actually, I'm going to hold off on that. Let's talk about the consent paperwork. Now, if you weren't aware or you didn't attend our Zoom the Rules that was last month it was me and it was my colleague, dr Ashley Stephenson Stephens we talked about rules, new rules for LPC, lmft and social work. Now, if you weren't able to attend that, don't worry, we'll have that out in your profile before you know it.

Speaker 1:

But one of the rules that has come out in the last couple of years, for those of you who are in a hospital or an agency or a prison where you're not able to get written consent, or perhaps they have already signed consent paperwork with the agency, with the hospital, with the prison, you have the option of asking your client do you understand the consent that you are giving right now? So you know, going over things like confidentiality, who's the records custodian, who ultimately handles whether or not their information can be shared, things like that. You can get their yes or their not and then you document that in their file. Now, private practice, that's different, right? Of course, you're going to have your own consent paperwork and it's going to cover those important things. So I'm talking from a clinical standpoint. Now Can you email them that paperwork? Because, again, if you are going off what you did in grad school or what somebody taught you 10 years ago you know I'm not saying it's right or it's wrong, but in the interest of time, remember that first session is also rapport building. You're helping that client trust you, you're helping them understand you will remain that non-anxious presence and you will be able to guide them to some solutions, right?

Speaker 1:

So if that consent paperwork is 10 years old, or if again, like that assessment, right, if it's something that's been Frankenstein together, I would invite you to go through the key points, and now I just wrote a few down. These aren't the key points, that would be another webinar completely but just what came up for me things like the divorce decree, chapter 611. And if you aren't familiar with chapter 611, you want to make sure you understand that. That has to do with what you say. Here stays here your fees and where to make complaints, because that's another thing Dr Stevens and I talked about in Zoom. The rules. You know that changed when BHEC was formed and that little document or that little square that most of us have in our consent form where can I go to make a complaint. Well, that has changed information. So if you haven't updated that, you want to make sure you do that.

Speaker 1:

But that's a big mistake if you're handing out things that are too long or they're old and they don't reflect recent rules, or you aren't really sure why you give it to them this way and it could be more efficient if you do it another way. Because, being mindful in that first session, yes, your job is to kind of turn on the fire hose and give them a ton of information. But anxiety up, cognition down, that's your client's ability to really comprehend and retain that information right. So we want to make this easy on them. So, depending on your population, again, you may be able to email them some of these things and then just go over key points in the first session. You may be able to pare it down to something you can go through in the first session, but you can go through it fairly quickly. All right, marketing hat.

Speaker 1:

I want to know if you did a 10-minute consultation with them and I want to know if you prepared them for the first session. Y'all, how many times do we hear or do we find out or do we hear from our friends and colleagues they think they're going to show up to the first session and deep, deep therapy is going to happen. Yeah, I mean, we know that. We know that's not the case. We know we need to get information. We know it's going to stay pretty surfacy because we're in rapport, because we understand this is a process. We haven't earned the client's story yet. Right, we're still helping them develop trust with us. We're proving ourselves to our clients. So in your 10-minute consultation and if you don't know what that is, go back to a previous training, check a podcast, check a YouTube video In your 10-minute consultation, did you prepare them for this first session?

Speaker 1:

Right? And if you did not, well, you might have a mismatch of expectations here. Right, and we know that happens. When you're buying a car right, you go there, you're expecting a Rolls Royce and they sell you a Pinto right, you have to understand. You're expecting a Rolls Royce and they sell you a Pinto right, you have to understand. You're selling a product and your client is expecting a product and it's nobody's fault here. Right, you know what you have to do according to the rules and best practices and ethics. But your client has shown up and they are paying for a service right.

Speaker 1:

In that 10-minute consultation you have the opportunity to help them set appropriate expectations, right? So you're not what is it? Over-promising and under-delivering, right? Whatever that term is. So in the 10-minute consultation it could be something as simple as hey just want you to know. In the first session it's going to feel like an interview. I'm going to ask you a lot of questions, I'm going to give you some points of views, some directions that we can take, and then at the end of the first session, we can both, or all of us can decide together which direction we want to go, and that will determine what we do in the second session.

Speaker 1:

Right, you see what I did there. I helped them set reasonable expectations for that first session. So they're not disappointed and say, well, therapy's dumb Counseling doesn't work. I went to this thing. All they did was ask me a bunch of questions. So, no lie, this had to be probably 20 years ago.

Speaker 1:

I finally because I was such a helper back then I still am, but I turned the volume down a little I finally got my neighbor to take her daughter to play therapy. I was so excited. I mean y'all, this was a tooth and nail. Kate Walker had to fight to get this person to change. You see what I struggle with, right? So anyway, put that aside.

Speaker 1:

My neighbor finally took her daughter to play therapy. They never went back. Here's why they never went back. Here's why they came back a few nights later, sitting with my neighbor out on the driveway. I said, okay, so how did it go? She goes, kate. All they did was play games. My brain, just. You know that. Well, neighbor, that's what they're supposed to do. Well, that's just dumb. If I want to play games with my kids, I'm not going to pay a therapist for that.

Speaker 1:

So you see what's happening here, right? You can guess the mistake, the critical mistake that this therapist made and y'all, this therapist was actually one of my professors, right? She did not prepare my neighbor for what play therapy was, what they could anticipate at that first session, how they could facilitate the process. And, of course, I know I'm getting one side of the story here out today, because part of your job in that 10-minute consultation is to help them understand what they can expect at the initial session, right? So if you are emailing them paperwork, let them know. Hey, I'm emailing you the intake paperwork. We will go over it in the first session. If you're going to email them an assessment, hey, I'm going to email you an assessment. We will go over that in the first session, okay.

Speaker 1:

So to recap, here's what we got. We've got clinical mistakes you can make in that intake session and we have marketing mistakes you can make in that first session. Right, and, depending on whether you're face-to-face or you're virtual, all of these things are impacting that dynamic that's going on inside your client's head. Right, anxiety up, cognition down right.

Speaker 1:

We are trying to help them trust us, right, and that means being the least anxious space in the room, preparing them for what to expect, making sure that our assessments and our intake are of our own design, making sure that our website copy and colors and fonts are selling what this person is going to get when they walk in the door or log in to that call. Right and be your authentic self. I mean, I want you to be your authentic self and we need to be clinical about what we do, because we're clinicians, that's why we hold a license, and we also need to be savvy marketers, right, if you're going to market to folks who work offshore and are having troubles with their marriage and struggle with circadian rhythms, then you better get trained and make sure you know what all of those things are. All right, I am going to open it up for questions, so let me hit the pause.