Badass Therapists Building Practices That Thrive
Welcome to Badass Therapists Building Practices That Thrive, the ultimate resource for mental health professionals ready to step into their power, grow their practices, and create a career they love. I'm Dr. Kate Walker, a Texas LPC/LMFT Supervisor, author, and business strategist who's here to show you the path to success.
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Badass Therapists Building Practices That Thrive
130 Deep Therapy Questions That Might Mean Your Clients Don’t Come Back (And Why That’s Okay)
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.
Thank you, okay, I am logged in. Hey, I'm Dr Kate Walker and today we're talking about questions that you can ask your clients so that they may not come back, and I'm with Jennifer Marie Fairchild who's going to ask me tough questions. Like you mean, I pissed them off, which is a good question. No, no, we're not going to piss them off. We're not going to do it on purpose. But thank you for joining. I'm so glad you're here so we can bounce these ideas back and forth. Yeah, so you're ready to let people in? Yep? All right, let's do it. All right.
Speaker 1:So questions that can help your client get better immediately. So that sounds like I'm selling snake oil, and Jennifer and I were talking about this before I hit record, because I was like, oh no, no, we got to do this on camera Because. So, jennifer, what do you think of when you think of a question that you can ask your client and then they may never come back, like I don't? Like, okay, did I say something to offend them? But like, what else do you think of when, when you think about that?
Speaker 2:I mean when I, when I think a solution, focus, like I really go back to the basics and it really is about like that miracle question, like what, what would your life look like if I waved my magic wand or had a crystal ball? What would your life look like if I waved my magic wand or had a crystal ball? And I think for some clients that opens the opportunity to like, oh, I need to go down this path and work. But I think for some clients they're like either they look at you like you're crazy, because they don't think that their life will ever look like what that miracle solution is, or they just I guess and it's unreachable, or they just think you're silly for even asking that. Like if I had a crystal ball, like I wouldn't be here. So sometimes, yeah, I just kind of go back to the basics.
Speaker 1:I think that's really true and I think part of that is our fault when we teach it in counselor education programs, because I don't think a lot of educators really believe in a solution-focused method. Now, I know there are a ton and many of my colleagues the solution-focused conferences coming up this and believe it or not, this conversation isn't really about even pushing solution-focused, but I think as educators we're like well, yeah, you could ask them solution-focused questions, but for real counseling you've got to go deeper, right? And so this is where I want to throw my disclaimer out. You know, I'm not talking about being dismissive. I'm not talking about pushing people out the door who have complex trauma or chronic conditions or persistent mental illness. You know, certainly this is not a one-size-fits-all, and if you've listened to me or watched me or sat with me while I taught a class, I will always tell you this is not.
Speaker 1:I don't teach band aids. This is something where if you, if you thought about OK, what can I ask this client that would help them see that there is a path forward, maybe without counseling. Like, what would that do to me as a counselor? Like, would I get my feelings hurt? You know what I mean. Would I be like right, because a lot of us even we talk about this in the Texas counselors creating badass businesses, setting client retention rates as a KPI, and I'm against that, right, I'm against having and I'm sure I'm going to get pushback and I welcome it. As you know, this is a safe space for all kinds of pushback, but the idea that keeping a client is a key to, or a KPI indicating you're being successful, a key to our KPI indicating you're you're being successful.
Speaker 1:Of course there is the client that's working on their treatment plan and yay, they're sticking with it and they're, they're powering through, and, oh my gosh, they're making so much progress.
Speaker 1:But then we also have an ethical obligation not to overtreat Right and. And so I know you've seen the threads, like I have, and you know it's, it's tough, it's a tough sell to counselors who are trying to build their bad-ass practices that thrive to say, yeah, don't worry about how long they stay right, let's just work. Let's work on the marketing, let's work on that 10 minute consultation, let's work, let's work on that intake. So I mean, like if I, if I could give you a magic well, I'm not going to say magic wand or crystal ball, let's take off the magic we're going to take, we're going to turn down the sparkle. What if I could give you a question that would make your client and I'm choosing my words on purpose that would make your client better, and you had to open a counseling practice knowing that this question exists that could make your client better? How would you feel?
Speaker 2:I feel like that's such a loaded question. I mean, ultimately you're in the business to help your client see progress, whatever that looks like, and so if they're, if they don't, I've had clients who've had trauma and I've had clients who didn't have a lot of trauma. They had a presenting issue issue Like if I had something that would help them get better quicker, as opposed to dragging it out for the sake of dragging it out, absolutely yeah.
Speaker 1:So, as a business owner right, because you're going to be a business owner here soon you know thinking about okay, how do I base my business then on this idea of three or four sessions versus 10 or 20 sessions? Like, how does that and I know I'm putting you on the spot right now, but you know how how would you think about your business then if, if you, if you, if you really flipped it to okay, this is, this is how we're going to build it, we're going to count on three or four sessions.
Speaker 2:I think that would change things a lot. I think it would change your marketing perspective too and the clientele that you target, because you're not going to market yourself. As you know a trauma informed, you know deep diving therapist, because those people are coming to you looking for long-term care. I mean I'm not going to say I specialize in personality disorders, because Right. So I mean I think really I would focus more on the marketing side of things so that I could keep that constant rotation and have a consistent client base.
Speaker 1:That I wasn't stressing, me too, me too Absolutely, me too, me too, absolutely. And and it's funny because, uh, when I got into practice, it was like 2007, 2008, when I really really, you know, said, okay, this is what I'm going to do full time. And then we had the recession of like 2010, right, I mean, it was literally like two years later and I was cash based and all of a sudden, it dried up, it was gone and I got on EAPs. I got on like three insurances and I am just going to own this about myself. I'm not cut out to be a person who files insurance and does that kind of thing and I ended up getting it was like a clawback. It was basically one of my clients who said, oh, guess what? You take my insurance now and they had been paying me cash all that time I was taking their insurance, so they had like a credit for six months. It was just.
Speaker 1:I remember being a new business owner thinking, oh, I am terrible at this, I'm just awful at this. And I went to a solution-focused conference and I don't even think it was a full-blown conference. There were a lot of people there, but it was really only two or three days. I remember listening to the presenter talk about these questions and how it could help clients see a path forward quickly, and so that was almost like the I'm going to use magic again. It was like a magic moment because it was like I needed something to help me shift my business, because I had to get out of the insurance business, I had to get back into cash and help me create a business plan based on exactly what you're talking about, jennifer a resource making sure I was positioning myself as an expert, making sure that I was a go-to person when people wanted to talk on this or a talk on that at the PTO or the Kiwanis Club, and it made my name get out. And so after a while it wasn't about whether this person was going to stay for one session or two sessions or four sessions.
Speaker 1:I was full period and so shifting to this model especially and I'm going to kind of bring it back around to this idea of finances what we have seen a lot in the threads in our groups is the economy's changing and, with all of these big companies coming around, it's almost like people who are used to this time of year being kind of in a surplus.
Speaker 1:They're not seeing it, and it was a thread recently I don't remember if it was in the Badass Group or the Texas Supervisor Coalition and I thought, okay, here we are right, it's cyclical, right. These things go go around. And now we are in a season where maybe our clients that we would rely on with insurance or that we would say are, are appropriate for 10 to 20 to 30 sessions. Now they're only coming for a few or not coming at all. So I thought I'd pull out the old solution focus thing again, but I'm going to throw in a few other things too. So you already kind of alluded to what's your least favorite solution focus question. That would be the crystal ball magic wand.
Speaker 1:Back to basics yes, I'm going to read off a few that people posted in the badass group. Um, in this moment, what do you sense your body is needing? Uh, what is stopping you? Can you remember a time where this wasn't a symptom? Tell me about it. Uh, imagine how it would look, feel, feel and how others would treat you if the symptom was better. How have you managed to make it this far? And so is that kind of what you think of when you think of solution focus questions. How often do you feel like you use them in your practice?
Speaker 2:Depending on the client, because I mean, like we've talked about, I work at, you know, an IOP and the way we're structured. We have interns approval for a year, so that gives me enough time to kind of go through the trauma aspect and kind of like pull out the deep stuff. But as we start nearing termination I shift to solution focus because I've got I know my time is limited and I've got to make sure that they're prepared for this evidence like discharge in a couple of months. So I do switch to solution focus, probably about four months before discharge, and that gives me a solid give or take with, you know, cancellations and no shows. That at least gives me a solid five to 10 sessions to like. Is there any lingering things that you want to, you know, work through what, what, what do you need so that when you leave this program you feel equipped to go forth and prosper in the world?
Speaker 1:So you and the client both have your eye on the exit door at the same time, you both realize that counseling is coming to an end, and so it's almost like the counsel or the the your client is working with you like, okay, I will play the solution focused game with you and I will play the solution focused game with you and I will suppose and I will imagine possibilities instead of where I was maybe six months ago when I was still in my trauma and it wouldn't have been appropriate for back then. Anyway, right, because they were nowhere near the exit door, correct.
Speaker 2:Okay.
Speaker 1:So then this may turn some people on their ear a little bit, because what we're doing is we're looking at each session as the last session. And I'm talking to you, private practice owner. I'm talking to you, standalone practice owner, who's not working in an agency or an IOP. I'm not talking to you who are working with personality disorders and persistent mental illness. I'm talking to you, private practice owner, when you've got somebody who's coming to you and this may be the one and only time you'll see them right.
Speaker 1:In fact, I remember my professor at Sam Houston State University, my I love this guy Dr Dr Bruin, and he's not practicing anymore, but he was such an influence on me and he told the class he goes guess what the average number of sessions is for a client and we're all throwing out numbers and he looks at us and he goes one one and I remember thinking, oh my gosh, that's so much pressure, like I got to hit it out of the ballpark with this person. I've got one session, but it helps. You think, okay, if this is the day that I work myself out of a job, what are the words that I can tell this person? So that dot, dot, dot, right, and we talk about that in the 10-minute consultation a lot too. It's like, okay, tell me what I can expect in the first session, tell me what I can expect in the second session, so solution-focused questions. But I came up with three more, so I'm going to throw this at you, jennifer, so do you ask medical questions in your intake?
Speaker 2:Ask medical questions in your intake, so like when I'm just doing myself, yes, I do ask basic, you know, are you in on any sort of like anxiety, depression medications? Do you have like a history of serious health conditions? Are you under a doctor's care? You know, and if you are like, is it family medicine or you know psychiatric stuff? So yes, because I do feel like that information is important.
Speaker 1:Absolutely yes, and I'm going to throw it at you as a way to get them to not come back to your office tomorrow. Perfect, okay. So in private practice, sometimes we'll get somebody who and you you probably know this too they sit down and you say, okay, well, when was your last physical, when was your last blood draw? And they're like never, oh, all right, or they're going. You know you're asking all the questions.
Speaker 1:You get to this part and they say, well, I had a heart attack recently and now I'm on all this medication. You're like, oh, so I or I'm, I'm diabetic, but I'm, I don't monitor it. Well, so you're, you're hearing all these things. Uh, or thyroid is another right, someone who's who has thyroid issues. Or or, like you know, approaching menopause, something like that issues, or, like you know, approaching menopause, something like that. And you can say to them stop, do not pass, go, do not collect $200. Before you come to your next session with me, go to the doctor and get a blood draw, right, I mean because you and I can talk our ears off and my mouth off and if you are still not addressing the underlying medical thing going on with you, whether it's endocrine or it's something to do with the medication that you're on because of your recent heart attack or who knows right? I mean, has that ever happened to you in practice, where you're just like wait what You've never had a blood draw A?
Speaker 2:couple of times and you're like, oh, or the last time you went to the doctor I was probably 10 years ago, and I'm like, right, yeah, and they'll tell you I'm healthy. But you know, they also say, but I'm pretty sure my blood pressure is high, or you know I'm overweight, or I'm not sleeping at night. Not sleeping is a big one, not being able to stay asleep once, falling asleep, and if we, as counselors, would.
Speaker 1:We're not going to practice medicine, so MDs, put your, put your phones down. But if we, as counselors, could become familiar with the symptoms of sleep apnea, right, the symptoms of, you know, unchecked diabetes, right? So those types of things you know, like a UTI, urinary tract infection with older people, right, that can often mimic dementia, you know we get a little loopy, right. And so, as counselors, if you can just become familiar with the symptoms of a physical ailment that mimic and duplicate and exacerbate the symptoms of depression and anxiety, and sometimes I mean, I worked with so many couples, you know you'd ask one person and the other one would go, be honest, and then they look at you and go she doesn't sleep. Or well, he's got a glucose monitor but he doesn't wear it. Or yeah, I can tell his blood sugar.
Speaker 2:He's got a seat nap and he doesn't wear it. Or, yeah, I can tell his blood sugar he doesn't see it happen. He doesn't use it. Yes.
Speaker 1:And suddenly you're like, oh my goodness, they're about to spend a lot of money on counseling when they could fix this by going to the doctor, right. So here we are, counselor in good conscience, kind of blowing up our KPI and saying please go to the doctor first before you come to the next appointment with me. And usually they're excited. I find they're like, oh my gosh, I didn't even think about that, and that's wonderful. And then they come back with all of these results and and it's, it's very helpful. So two more questions. The first one Okay, I'm going to pretend like you're my client, jennifer. If you came and sat down and we're like, hey, how are you doing? Ok, and I looked at you and I said, ok, how can I help you today? Silence, silence, silence. As a client, how would you feel?
Speaker 2:Like I was put on the spot and I would probably do what I do every time I go to the doctor, because we are, we are conditioned as a society and as women to be fine and nice and, you know, congenial. And so I go into the doctor and they're like what brings you here today? How are you feeling? I'm fine, I'm fine, and I just smile and act like I'm just in the bit old, knowing that I have a list of a million things that I was supposed to talk to them about. So I would tell you that I'd be like I'm fine and I'd start to wonder why I even made the appointment to begin with.
Speaker 1:Yes, did you know, pavlov's dog, that our clients can actually get cued to become problems focused by our very office, by the act of pushing the button to go on to Zoom right? And we know that we learned that in Behavioral Therapy 101, right Ring the bell, the Pavlov's dog salivates. And so if you can start to shift that first 30 seconds, first two minutes of your session to how can I help you today? And they recognize, or what would make this a great session today? What do you need from me today? And I normalize a client saying nothing, I'm good, I just didn't want you to charge me the full session because I canceled late. Right, I mean, I've had that happen before. I'm like, oh, so sorry, you want to play cards? No, but right, I mean, because if you went to a counselor and they constantly said constantly, and you knew you were conditioned that every session you would be greeted with how can I help you today? What would make this a great session?
Speaker 1:And again, I feel like I need to put the disclaimer out there we're not talking about pervasive and persistent mental health issues, right, we're talking about folks who just come in and they're wanting to work some things out and they answer well, not much. Would you congratulate them? I would, yeah, right, it's like amazing, you don't need me today, right? No-transcript, I'm not going anywhere. But if they say no, I'm good and we say, yay, good job you. You know that's I mean, that's empowering, that's empowering, that's what we're here for. Okay, my last question If you were my client and I looked at you and I said, okay, do you want to come back?
Speaker 2:I would. I don't know. I mean, I would probably feel like I needed to say yes, but if if you made me feel like I, like, had the tools already, I just didn't realize it no, I might not come back and I'd probably save that fee.
Speaker 1:And again we're back to Pavlov's dog, right? Because so many of us, when they're done with the session, we kind of pivot our chair, we reach for the calendar, we open it up on a okay, what same time next week. And if we looked at our clients at the end of a session and said, so do you, do you think you need to come back, Do you want to come back? Again, it's going to be shocking the first time, just like, oh crap, you mean, it's up to me, you're the doctor, I'm not a doctor, right? So no, it's really up to you, client, it's really up to you. And do you want to come back? And if they say, well, I don't know, maybe in a month, great.
Speaker 1:Now I will say I have told people I think you need to come back sooner and we'll review their goals. We'll review the treatment plan and I'll say if it, especially with addiction and some more persistent issues, I'll say things like look, if you, if you come to see me every once a month for the thing you're dealing with, you're wasting your money Like this, this won't work, right? So we always default to our clinical judgment, our theory, our knowledge of the client's issue and we preserve their autonomy. That's all we're doing with these questions is we're preserving their autonomy, we're reminding them, we're conditioning them to remember. Hey, you've got a say in this too, so I mean, not too bad right, we had solution-focused questions, medical questions how can I help you today? And do you want to come back? Are there any you can think of, jennifer, Questions that might make your client not want to come back? I guess not.
Speaker 2:I can't think of any.
Speaker 1:Okay, do you think you would ever use these in private practice?
Speaker 2:Absolutely.
Speaker 1:Cool, cool. That's a good endorsement. That means a lot coming from you. All right, I'm going to open it up to questions. So pause.
Speaker 2:I think Kathy's saying something Uh-oh.
Speaker 1:Kathy, I'm going to hit pause and pause.