65: How Many Clients Does a Therapist Have?
You’re tired of trying to figure out how many clients you need to see in private practice. You’ve asked around, tried to mimic a caseload based on your agency days, but something doesn’t feel right. Do you see 10 clients a week? 40? 100? In this episode, I’ll break down why an “average caseload” for therapists is a relic of days past, and how to think about your private practice caseload sustainably.
If you are a visual learner, you might want to check out my corresponding blog post that shows all of these sample therapist schedules, too.
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I published a blog post on MindMoneyBalance.com on February 22nd, 2021 that has more or less really driven this traffic to my site, and it's all about the average caseload for mental health therapists. I find it fascinating that blog post is the one that is bringing people into my website and has people consuming what I have to say basically.
And what I think is so interesting about this particular post taking off is that it's so, um, indicative of the way in which therapists are when it comes to running their businesses, meaning as therapists, we are trained to hold space for that in Betweenness to be able to experiment with our clients, to offer many, many suggestions to our clients without, you know, prescribing "do this one the exact way and everything will work," right? That's not how therapists operate. We operate under this, under this umbrella of giving our clients a choice over what they choose to do. So I think it's so interesting that when you flip it around, and you take a look at entrepreneurial therapists in private practice, how they want black and white answers. They want to know my clients when they work with me, how much should I charge per hour? How many clients should I see per week? Should I work nights and weekends? Is this niche okay? They want me to give them permission for how to run their.
And I don't do that. I really believe that each person's practice can and should look different. I don't believe in a cut and paste practice where every single person sees. You know, 15 to 20 clients a week, works Monday through Friday, has this specific niche, has a brick and mortar. I don't get done with that.
I think all of us have different strengths and challenging areas, and we have clients that we love working with, and we have clients that we know we're not a good fit for. So all that to say, we as therapists really want to know the right answer when it comes to building out our practice. But I think it's important for us to really sit back and sit with that sensation of just trusting ourselves a little bit more and building out our businesses in a way that support us instead of in the way that somebody down the road has built their practice or somebody online who you've never met has built their practice.
So let's shift into the million dollar question, what is the average caseload for mental health therapists? And the reason I think people are googling this is they want permission to see fewer clients, or they want somebody to tell them that, wow, X number of clients a week or a month is too many.
And here's what I have to say about caseloads for mental health therapists. They are arbitrary. They were set for us as mental health clinicians, as psychologists, as social workers, as counselors, by other people, by other institutions. Oftentimes, they were set in an environment where the number of clients that we see or manage or have on our caseload is tied to money, tied to if you're in a, um, a government allied agency, like a community mental health, uh, like a public hospital. Like a public school, you have to see x number of clients in order to be paid because so many of those, um, businesses are supported through grants. So you have to demonstrate that there is a need. For your services, meaning you have to see X number of clients.
So that's one pocket of where this idea of a caseload comes from is, is anybody who is in a public funded institution and they are doing grant based work, where in order to have their grant met or potentially get that grant, again, they have to see so many clients. Then on the other side, you have agencies or for-profits who are mandating a minimum level, a minimum number of clients to be seen for their own bottom line.
But at the end of the day, these numbers weren't built out of what's best for the client, what's best for the therapist, where are outcomes the most beneficial, and what we know is that look, your full is going to look different than my. Pre pandemic, I could see five, six, maybe even seven clients a day.
Not all the time, of course, but I could do it. It was something that, you know, I could do once or twice a week if I had to. If I had to shuffle some people around for a long weekend, it'd be totally fine for me to see that many clients now. During the pandemic, um, because at the time of this recording, it's still going on let's not forget. Um, just because vaccines are rolling out doesn't mean that the pandemic is over just because we're sick of it happening. Um, but I'm doing all online therapy or 99.5% online therapy and I find that I am getting so much more drained being behind the Zoom screen. That doesn't mean I'm gonna give up online therapy.
I actually really, really love it, but I've learned that I can't do back to back to back clients like I used to be able to do. I need a little bit more space in my calendar, both in between clients and just in terms of the day to day caseload. So for me, I want you to build your caseload with the end goal in mind. The end goal being how much money do you want to make and how much do you want to work? Those two things are your end goal, and then figuring out how many clients you need to see at what fee that is the problem you have to solve for.
So for me, I know not a morning person, I will never be the person who gets up at 5:00 AM, meditates, goes for a run, drinks my tea, and starts seeing clients at 7:00 AM That's not me. I know plenty of people who are, who are super energized first thing in the morning, and that's when they do their best work. Kudos to them. That means they get to see a subset of the population that is also early birds, or maybe they've got time zone differentiations and they're able to knock out a few appointments before 9:00 AM good on them.
But that's not me. Just because somebody else says that that works for them doesn't mean it's gonna work. Similarly, I like having Mondays be my admin and creative day. It's been that way since I wrote my book, the Financial Anxiety Solution. I started taking off Mondays because I realized I couldn't see clients and write my book at the same time.
It was too hard for me to shift between clinical Lindsay and author Lindsay. So I moved my clients to Tuesday through Friday and started doing my creative work, my writing work on Mondays and I. So much that I kept it well beyond the time when I submitted my manuscript to my publisher. So for me, Mondays are no client days.
Tuesday through Friday I do see clients, but on Fridays I end early so that I can have the rest of Friday afternoon to do all of my catch up work, to catch up on notes, to send out those final few emails so that I can head into the weekend knowing that I've kind of tied a bow on my work week in. In terms of how many clients I see per week, right now, I'm seeing between 12 and 15 because I know that I can financially support myself on 12 and seeing up to 15 is kind of, uh, two things.
It acts as a little bit of a bonus, because I can make what I need to make with 12 clients, and then it also serves as a little bit of a buffer in that if I have 15 clients technically on my caseload, if two of them are out on vacation and one of them's sick, I'm still seeing my 12 clients a week. So that is how I have done it.
In the past, I've ranged from 18 to 25 clients depending on my energy levels, but really the more I have gotten in tune with how I best work in terms of seeing clients kind of from 10:00 AM to 4:00 PM that's kinda my sweet spot for client work in terms of not seeing clients on Mondays, Saturdays, or Sundays.
And in terms of setting my fee at a sustainable number that allows me to show up, rested and provide good work to my clients, that's what works for me for now at the time of this recording. It very well could change because again, as humans, as therapists, we are bound to change with different seasons in our lives.
So that's such a therapist answer, which is, it depends. But I hope that this helps you to see that there is no one definition of full. My full is gonna be different than your full. And your full is gonna be different than somebody else's practice down the road.
I'm also an experiential learner, so for me it's helpful to see how other people lay out their schedules. So I already told you a little bit of what my schedule looks like. Let me go over a couple other schedules that are "nontraditional" in that they aren't just a nine to five Monday through Friday.
So I've got an early bird therapist schedule, the night owl therapist schedule, and also the weekend warrior schedule because some of us need to work on weekends. Um, so let's start out with the early bird sample schedule. So this is for my folks who are early risers. They have that early bird sleep chronotype. And so in this scenario, in this example, they front load their therapeutic work at the start of the day when they're freshest, and then they save the end of their day to do administrative worker admin time. So everybody's different. I think a lot of therapists are able to do three or four sessions in a row, some people aren't.
That's totally fine. Just take this as a sample, as an idea. Do not get married to this idea. If you're an early bird and then you listen to me share this schedule and you're like, ah, I would never do that, that's okay. Just take it with a grain of salt. It's just an example. So for example, let's say the early bird therapist likes to work Monday through Friday and see about 20 clients a week, right?
So that's four a day. So they would work from 7:00 AM to noon, seeing four clients in a row with a 15 minute break in between. They'd have lunch from 12 to 12:30, and then from 12:30 to 1:30 they'd do their admin time, and then they're out the door by two o'clock. So that is one example of a schedule.
Now, if you are a night owl, which interestingly, I'm actually not a night owl, I'm the bear sleep chronotype, which means I go to sleep when the sun sets and I wake up ish when the sun rises. But for a true night owl, this sample schedule focuses on a clinician who has more energy in the afternoons and in the evenings.
So in this example, the therapist has their admin work at the start of the day. So maybe they do yesterday's notes in the morning, or they're doing their calls back to clients in the morning, or they're doing their emails in the morning. Um, and by morning, I mean. The afternoon, as you'll see, and then they see their clients for therapy in the evenings when they're at their peak energy, right?
So a Monday through Friday night owl schedule could look like Monday through Friday, seeing 20 clients per week. So again, four clients per day. 3 to 9:15 PM could be their example schedule. So from 3 to 4 is their admin hour, calling clients back, doing notes from the previous day, doing care coordination and what have.
Then from 4 to 6:15, they see two clients. They take a little 15 minute break in between sessions from 6:15 to 6:45, they have their dinner, and then from 6:45 to 9, they have their final two clients again with a 15 minute break in between sessions. So that is an example of a night I will schedule now.
The next schedule and the last schedule that I'll share with you is this Weekend Warrior Therapist schedule. And the weekend warrior schedule works really, really well for the therapist who wants to, or needs to be on be at home rather for the work week. So this one is really set up to see fewer clients because it's hard to see 20 clients in two days, and I definitely don't recommend it.
But really what they do is kind of see people Friday, Saturday, and Sunday. So three days a week. Um, and they see 15 clients over those three days. So they're seeing five clients a week instead of the other examples where people were seeing four clients a week. But you can play around with it. Again, this is just a sample.
So let's say you've got this weekend warrior and they are. For, because they have to be or because they want to be Monday through Thursday. So from Friday to Sunday they work from 9:00 AM to 4:30 PM and they have their 15 clients in those three days. So from 9:00 AM to 12:30. They have three clients with the 15 minute break in between each.
Then they have their lunch from 12:30 to 1:15. And then from 1:15 to 3:30, they see two clients again with a 15 minute break, and then they save that last hour of their day from 3:30 to 4:30 to do their admin work, and then they're out the door by five. So I hope just seeing some of those examples or hearing some of those examples rather, is helpful.
I know for me, when I was playing around with my caseload, I liked to hear from other therapists to see how they set up their days, not because I necessarily wanted to mimic them, just so I could get a sense of how people made private practice work for them. So I invite you to think about what is your ideal.
Load again by reverse engineering it. How much money do you need to make in a year and how many clients do you wanna see in a. And how much do you wanna work? So just find those numbers and work your way back so you can figure out how many clients you need to be seeing. If you have done this exercise and you've loved it, but maybe you're struggling to implement it, or you're not really sure how to go about charging those fees or raising them to a sustainable rate, I'm really excited to share with you that I'm reopening inside out.
Actually called Grow a Profitable Practice From the inside out. My three month group coaching program for private practice therapists. This is really, really helpful for folks who have an on the side practice or who've thought about private practice and want to grow their practices sustainably. By first rewriting their money stories in a healthy, non-spiritual bypassing way, setting sustainable fees that support their unique lifestyle, kneeing down and calling in aligned clients on a beautiful and hardworking website, and learning which metrics you need to track so you can know what to do for your practice and what is moving the needle in it.
Um, at the time of this recording, Just, um, enrolling people in the program. I'm just getting ready to, so if you wanna be notified and wanna be one of the first people notified, make sure to go to mind Money balance.com/profitable practice. Depending on the time of this recording, you'll either see a add name to the wait list button or an applied now button.
Add your name to the wait list now, if you're listening to this in real time. And I am running this for the final time. In 2021, I took a look at my numbers and my energy level and mapped out how I want the rest of my year to look. And so in practicing what I preach, while I could cram into cohorts of inside out, since it's the three month program, I wanted to be really intentional about my energy and attention, and ensure that folks who enroll in this cohort are, have me and fully present me, scatterbrained me. So if you are considering joining, I would love to have you join the wait list or apply again, that's at mind Money balance.com/profitable practice. We will kick off in September and wrap up before American Thanksgiving and Hanukkah. So it's a nice fall back to school Energy and Vibes.
And with that, I'll see you next week.