Q: I work at a local community mental health service, and have recently started a part-time private practice. I receive calls from potential clients, but rarely get them to arrange a first appointment. What am I doing wrong?

A: Making the shift from an agency setting to private practice is more complex than it may appear at first glance. At an agency, clients are routinely assigned to therapists. Clients who come to an agency or HMO already have confidence in the organization and, consequently, in their staff.

Quite the opposite is true for a private practice. In this case, it's up to you alone to establish confidence in your clients. You can do this by building a relationship with potential clients that begins before you have direct contact with them. It begins with your business cards, your promotional materials, and how you respond to client inquiries. Let's look at some of the ways you can make yourself more successful in converting first contacts into client appointments.

Back to Basics: Learning the 3 Rs

I've developed a system of 3 Rs that are basic to attracting clients to your practice. They refer to the therapist's ability to be Reachable, Responsive, and Reassuring. Let's look at how the first R applies to your business cards and marketing materials.

What do your business cards and promotional materials say about you? Is your name followed by a string of initials? If so, you're creating barriers between you and your clients. To begin with, most potential clients can't distinguish between an M.S.W., A.C.S.W., B.C.D., or L.C.S.W. Furthermore, those who understand these distinctions know that there's no connection between how many initials you have after your name and how effective you'll be in helping them. Similarly, the words, "by appointment only" add no information to your business cards. What the words may accomplish, however, is to convey an impression that you like formality and you want to discourage clients from calling you. Do you really think that if you delete "by appointment only" from your card you'll have clients knocking at your door at all hours of the day?

Let's look at the second R and see how it applies to your client's first contact with you. Whether you use an answering service or some form of answering machine, your client should feel welcome when he calls your office. Again, your goal is to eliminate barriers between you and your potential client, and to create a high level of comfort for the caller.

Here's the message I use on my voice mail:

"Hello, you've reached Barry Silverman at the Brief Therapy Center of Staten Island. I'm sorry I'm not available to take your call right now, but I'm looking forward to talking with you. Please leave your name, number, and a brief message, and I'll return your call as soon as possible. Always leave your phone number and your full name, even if you think I already have it. Thank you for calling."

Note that my message is designed to capture the necessary information as easily as possible and to set a positive tone for the caller. It's businesslike but welcoming.

It's conversational, not stilted. I don't dwell on my degrees or credentials. I politely invite a caller to leave a message. This all may seem quite basic, but I'm frequently complimented on my message.

You'll also note I don't begin my message with, "Your call is important to me." I happen to dislike that phrase intensely. Anyone who's ever been through a series of endless prompts that started with "Your call is very important to me" knows precisely how insincere that can sound. Merely saying that a call is important doesn't make it so. It's far better to show your callers their calls matters by responding rapidly and in a helpful manner.

Get There First

If you're new to private practice, many of your potential clients will have gotten your name from their insurance company or through your marketing efforts. In these cases, all therapists are equal, and potential clients will often arrange an appointment with the therapist who returns their call first. It's particularly important, therefore, that you return calls as soon as you can. I can't overemphasize how important it is to return calls as promptly as possible. Even though clients rarely reach me directly on the first call, I'm able to convert a high percentage of first calls into appointments because of my responsiveness.

I return all potential client calls, even if I know the call isn't likely to develop into an appointment--when a caller is asking if I participate in a particular insurance plan or if I specialize in an area that's outside my expertise, for example. By responding to these calls, as well as to the more promising ones, I build a reservoir of goodwill, which helps me develop a positive reputation in the community.

Reassure the Caller

Once you make direct contact with a caller, your objective is to  schedule an appointment. A potential client needs to be reassured that he can be comfortable talking with you, can safely tell you his story, and that you're professional and competent. Therapists new to private practice often lose sight of these goals and get caught in a maze of what a professional is supposed to sound like.

When I return an inquiry for therapy, I begin by saying, "This is Barry Silverman returning your call. How can I help you?" My wording is deliberate and precise. I quickly identify myself and reinforce the idea that I'm there to help. Early into the conversation, I ask the caller, "How did you hear about me?" His answer provides important information about how to handle the call. The most important reason for asking how the caller was referred is to gauge how committed he is to hiring you as his therapist.

As I indicated earlier, all first calls are not equally likely to translate into first visits. One deciding factor is how connected the client feels to you. The more connected the client is to you, the more likely he or she will hire you as his therapist.

Let's look at two hypothetical callers. The first caller, Alice, was given your name by a friend of hers who came to you for marriage counseling. Alice is having a crisis in her own marriage and wants help. The second caller, Beth, is also calling you about marriage counseling. She and her husband haven't been communicating for the last few weeks. She found your name from the phone book under the heading "Counselors."

All things being equal, you're quite likely to become Alice's therapist. She has great confidence in her friend's recommendation of you. When Alice calls you, she already intends to make an appointment. You won't need to work hard at selling yourself or distinguishing yourself from other therapists. Even if you can't return her call immediately, she'll probably wait a reasonable amount of time before calling another therapist. This type of call, from a direct referral source, is the most promising.

Beth, the second of our callers, knows nothing about your background. The most effective way to handle a call from a nonspecific referral source is to narrow the distance between the caller and you. I'd do this by asking Beth if she knows anything about me. If the answer is no, I'd say, "I've been a therapist for 25 years and have been in full-time private practice for 9 years. I've helped many couples with marital difficulties." If you're just starting out in private practice, but have been working for a community mental health center, you might say, "I've been a counselor for 6 years and have helped many couples with marital problems." Don't lie or exaggerate your experience or qualifications, but do let the caller know what it is about your background that qualifies you to help her.

After I've given the caller a sense about myself and my background, I ask if she'd like to schedule an appointment. If the answer is yes, I ask when she'd like to come in, rather than suggesting a specific time slot. I want to demonstrate flexibility and responsiveness on my part from the very beginning of our relationship. I then schedule her for the appointment time closest to her request.

To Fee or Not to Fee?

Therapists who consult with me often ask whether to discuss fee issues during the initial call. Many times, a potential client will ask early in the conversation whether you take his insurance. If, however, the client doesn't raise the issue of fees, I ask toward the end of our conversation if he'll be using health insurance. I let him know whether I participate in his insurance plan and, if not, what my fee is. I add that I can make exceptions for people who have difficulty affording my rates.

The last part of the call gives you the opportunity to provide your clients with any additional information they may need in regard to their appointment, such as directions. I tell my clients, for example, that my office is near a local hospital and is in a private house. I also ask them to let me know ahead of time if they're unable to keep the appointment, so I can free up their time for someone else. I don't make a formal pronouncement about my cancellation policy. That would put people off, and is, for all intents and purposes, unenforceable for a first visit. Finally, I let clients know that I'll be confirming our appointment before the visit.

I make it a point to confirm all of my appointments personally. I do this both to provide an extra service to my clients and to avoid potential scheduling errors. The vast majority of my clients like this added touch.

Remembering to incorporate the 3 Rs--being Reachable, Responsive, and Reassuring--can greatly increase your effectiveness in converting initial calls into first appointments. As you become more experienced and develop a broader base of referrals, you'll find that first contacts will not only become easier to manage, but will also require less effort.

Barry Silverman, M.S.W., is director of the Brief Therapy Center of Staten Island. He combines 25 years of clinical experience with training as a life coach to help therapists develop professionally. He also consults with therapists wanting to expand their private practices. 

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