One of the big problems therapists have is they don't know how to get more clients. And getting more clients, make no mistake, is the name of the game. You can be the greatest therapist in the world, but if no one is calling your phone, it doesn't matter.
To better understand how to get clients I've been studying Alex Hormozi. He's a business man who's taken three businesses from 0 to $20 million and now buys companies and takes them from $3 million to $20 million (or something like that).
In his spare time he makes videos on how to run better businesses. In this post I'll adapt his thoughts on referrals so they apply specifically to therapists.
Let's dive in!
How to get more clients: Get other people to market for you
The best way to get more clients is to ask people you know to send you more clients.
This is for two reasons.
First, when people send you more clients there's a transfer of trust. If my mom says I have to go to this restaurant then I go, simply because I trust my mom.
Second, having other people send you clients is scalable. It's a lot of work to get 10 clients.
It's also just as much work to get 10 referral sources. But if 10 referral sources send you 2 clients, you've gotten 20 clients. Same amount of work but twice the clients.
In the marketing world they draw a line between referrals and affiliates.
A referral source is someone who uses your product or service who then refers someone else.
An affiliate is someone who is also a provider who sends you clients.
So if a client sends you a client, she is a referral source. But when a psychiatrist sends you a client the psychiatrist is an affiliate.
This is super important because both referrals and affiliates require different strategies, especially for counselors.
Clients as referral sources for counselors in solo private practice
For most businesses the answer for getting more referral sources is to simply ask for them.
This sounds so obvious that it's dumb, but apparently most businesses simply don't ask. So if you're a chiropractor, massage therapist, personal coach, you should be asking your clients to send you clients.
But, we're not chiropractors. We're therapists and counselors. And our ethical code doesn't smile on asking clients for referrals.
What the ethical code says
Technically, neither the AAMFT or the ACA codes of ethics prohibit asking clients to refer to you . However, there's a clear ethical imperative to handle referrals in a way which benefit the client over benefiting you. The idea is you shouldn't use your position as a therapist to put undue influence on clients to refer to you.
This is why I wouldn't ask clients directly to send you other clients. It just gets too close to crossing the ethical line.
That being said, your state laws might be different, or maybe you use a different professional code.
If I were you, I'd just send an email to your board and ask "can I ask clients for more clients?" Sometimes state boards won't answer questions like that. Which is a problem. They should be able to offer clear guidance.
If they won't answer the question, contact your professional association. For instance, when I was a member of AAMFT they had a lawyer you could consult with for various issues. So I could call the lawyer and ask them "can I ask clients for more clients?"
The ethical way around the ethical code
However, I think there's an ethical way around this. You can passively state that you take referrals. I knew a therapist whose email footer read something like:
My business is built on referrals. Any referrals you send are greatly appreciated!
I do the same in my solo private practice.
I have a monthly newsletter I send out to clients. This monthly newsletter is clients facing (as opposed to this blog which is for therapists) and I automatically add clients to it (I go over it in our intake).
While I put lots of different content in my newsletter, I mainly send the newsletter to remind my clients that I'm still here. I want them to think of me when they need to refer a friend to counseling. And of course in the newsletter I say "I'm accepting referrals."
Doing it this way doesn't put undue pressure on clients to send me clients because it's not a direct ask.
The problem with referrals.
The big problem is clients only refer if doing so makes them look good. Which means, if you're banking on word of mouth referrals to fill your solo private practice, you had better be pretty stinking good! [1 this is why client generated wait lists are a marker for being an exceptional therapist.]
Are you really that good? In general 50% of clients experience some change while in therapy with only 25% recovering. So if you're seeing 20 clients a week then only 5 of them have recovered, but you can't ask them directly for clients. So they'd have to be so blown away that your name instantly comes to mind when a friend says "hey, I need a counselor."
That's a tall order.
When I talk with therapists and really dig into their processes, therapists often think they have great word of mouth but what's actually happening is:
They have great affiliate relationships (a pastor, principal, physician sends them lots of clients, NOT other clients sending them clients.)
They do lots of speaking engagements so audience members are impressed and then seek them out.
They do get some client generated clients, but their average client comes for a long time (upwards of 35 sessions) so they only need 1 new client a week to keep them full.
This leads me to believe that most therapists don't have a large number of word of mouth referrals.
Which is not surprising. For a good business, which can ask directly for referrals, industry standard is that 30% of clients come from word of mouth referrals. So with all the effort for only 30% of clients I wouldn't worry too much about it. Make a passive statement in your email or newsletter and then move on to finding affiliates.
Affiliate marketing for counselors in solo private practice
As I observe the field, affiliates are much more important than referral sources. One good affiliate can make a solo private practice.
The problem is most potential affiliates are busy and aren't thinking about your practice.
When I started my second practice (which failed) I reached out to something like 70 churches. My thinking was pastors often have couples who come to them for help, and since I wanted to specialize in couples, if I could tap into that market I'd have a booming practice in no time. I got like 3 responses. One of them was a pastor who was actively disdainful of counseling. Another became a friend... who also still never referred me a client.
The other 67 reach outs I never heard back from.
I've worked with counselors who've tried something similar with schools. They'll go to a school and leave a flier for their practice in every teachers' mailbox... and hear nothing back.
So what do you do?
In the business world there's an understanding that affiliates have to be "activated." If they don't have an incentive to send you clients they won't, so you have to give them an incentive.
Traditionally you do this by kickbacks. So if I'm an affiliate with a massage therapist, for every client I send her, I might get $20 bucks.
But, according to the ACA and the AAMFT kickbacks are bad. They twist the incentive structure. We don't want you sending clients to someone just because they are paying you.
So what do you do?
First: do more volume
The truth is I massively underestimated how much effort it would take to get an affiliate.
I reached out to 70 potential affiliates and then stopped because I wasn't getting any feedback. The rule of thumb is that I should have reached out to 100 potential affiliates per day for a 100 days.
I simply wasn't doing enough volume.
For instance, a friend of mine sent out business postcards and pamphlets to all the hospitals in the area which took BCBS, the only insurance provider she accepted. I think she sent out like 200ish business postcards and got like 5 clients.
If that's her conversion rate then she knows if she sends out 1000, she should get 25 clients.
I think most of us fall into this trap. We simply aren't doing enough volume.
Pro tip: track your metrics.
You only know 200 business postcards will give you 5 clients if you track your metrics. The most important metrics are
How many reach outs you did (calls, business postcards, etc.)
Number of new clients
Affiliate source (which pastor, principal, physician is sending you the most clients).
Once you know who's sending you the most clients, you can focus your efforts on building those relationships.
Second: befriend a gatekeeper
Gatekeepers are the guardians of a network. If you can befriend a guardian they often will send you clients for forever.
For instance, a buddy of mine made friends with a couple local pastors. These pastors are gatekeepers for their churches and they refer all their couples to him.
Another friend of mine worked in schools for 20 years before becoming a counselor. She was a gatekeeper and now knows all the gatekeepers for local schools. She gets tons of teens and families asking her for services.
Another friend knows all the other couples therapists in the area, all her friends all have waitlists and they just send her their overflow.
I think befriending a gatekeeper works particularly well for therapists who are already close to a network. If you're on the Parent Teacher Committee at your school, reach out to your school counselor. If you're Catholic talk to the local priest. If your favorite professor is into play therapy ask him to introduce you to his play therapy buddies.
This is why my mentor Wesley Little suggests meeting with therapists who are in your niche and have overflow and asking them to refer. After all it's what she did. And I totally believe it works.
Third: make content for affiliates
The downside of befriending affiliates is it's easier said than done.
First, the gatekeeper has to really like you. Which means you have to be exceptionally likable.
Second, the gatekeeper has to really think you can help their network. For instance, my area is heavily Emotionally Focused Couples Therapy. If a Gottman couples therapist came to town and tried to meet with the EFCT gatekeepers they wouldn't get anywhere. The EFCT gatekeepers just don't believe she can help their clients.
Third, you have to find actual gatekeepers. As we discussed earlier most therapists aren't really gatekeepers. Their strength isn't getting clients, but retaining clients. They only get 1-2 calls a week, but because they keep clients for forever, they only need 1 intake a month to keep their practice running. If you meet with this person they probably won't have clients to give you.
Fourth, true gatekeepers are always busy, so it's often really difficult to get in front of them.
With all of these barriers what are you to do?
Well, my work around is to give first. The idea is to identify a network you work well with, figure out what their needs are and do what you can do meet their needs.
I know this sounds kinda vague so I'll give you one example.
Case Study: Joi McGowan
A friend of mine Joi McGowan, does a lot of speaking in the area. She speaks at churches, community centers, art centers and the like. This sounds like she's providing a service for their audiences, but really she's serving the people who hired her. She makes them look good when she speaks. If they have a banger of an event, then more people want to come to their event. This puts her on their radar for referrals in the future.
If you get on this sort of speaking circuit I'd recommend two things.
First, clients are more valuable than money.
These sort of speaking circuits often pay some sort of small fee. It's usually not much. My experience has been between $50-$200. I think you should ask the person setting up the event, "hey, let's set it up so I get the emails of everyone who comes to my event. I want to add them to my newsletter."
This is because of a concept I've talked about before called lifetime value. See if you charge $100 and a client comes for 20 sessions, this means that client is "worth" $2,000.
So you can either make $200 from the event, or get a $2000 client.
Of course, some of you will think "well that sounds scamy. I don't want to do that. I don't want to trick people into being in my newsletter."
Okay, cool. This is more of a principle, or a framework, than a hard and fast rule.
For instance, instead of adding the emails to your newsletter, you could ask the agency to showcase you in their newsletter.
Or you could ask to be reoccurring speaker. That way you get multiple exposures to their audience.
Or you could connect them with another group in town who needs their services. There are a bunch of creative strategies. The big idea is don't get so obsessed about the short term money that you miss the long term pay out. Trade the short term money for the long term collaboration.
Second, record all of our content.
I've no idea if Joi is doing this, but I'd be recording all of my speeches if I were her.
Remember, as a solo practitioner you are busy. Anywhere time you can repurpose content the better. You want to get maximum use out of the content that you're making. If you give a speech once you're doing a lot of work for a once time pay off. You want to record that so you can get multiple uses out of it.
Once you have it recorded you can repurpose it for your newsletter.
Pro tip: the 5-1 ratio
When Paul and I first met with gave a series of hypnosis trainings. Several of the counselors sent us clients. When we asked them how many they sent us and compared that to how many actually called, we found we had a 5:1. For every 5 clients they recommended, 1 would reach out to contact us.
Our method was just verbal report, so obviously it wasn't very official. Still, I can't imagine the ratio is better than that. At best, for every 5 clients an affiliate refers, you'll get 1 phone call.
So that's it. That's what I've learned about using affiliates and referrals to get more clients from studying Alex Hormozi.
Over the past few weeks several of you have signed up for our free consultation services. It's been great to meet with you and discuss your solo private practices.
All of you, and by all I mean all, have had the same presenting problem. My wish is that by researching all this stuff I've shortened the time it takes for you to get full.
I hope I've made building your practice a little easier.
Referral sources are clients who send you more clients.
Check with your state board/ governing body about asking clients directly for more clients.
Use an indirect method, like a newsletter, to broadcast that you're accepting referrals.
Affiliates are other providers who send you clients.
You have to do a lot of reach outs to get your first affiliates.
When looking for affiliates befriend gatekeepers of a network.
Instead of asking the affiliate for clients, lead with offering them something valuable. One way many counselors do this is by speaking/presenting.
Jordan (the Counselor)
 In researching this article I pulled the relevant codes from both the ACA and AAMFT code of ethics. They are shared below for your reference.
AAMFT code of ethics
Marriage and family therapists respectfully assist persons in obtaining appropriate therapeutic services if the therapist is unable or unwilling to provide professional help.
8.1 Financial Integrity.
Marriage and family therapists do not offer or accept kickbacks, rebates, bonuses, or other remuneration for referrals. Fee-for-service arrangements are not prohibited.
A.10.a. Self-Referral Counselors
working in an organization (e.g., school, agency, institution) that provides counseling services do not refer clients to their private practice unless the policies of a particular organization make explicit provisions for self-referrals. In such instances, the clients must be informed of other options open to them should they seek private counseling services.
A.10.b. Unacceptable Business Practices
Counselors do not participate in fee splitting, nor do they give or receive commissions, rebates, or any other form of remuneration when referring clients for professional services.
C.3.d. Recruiting Through Employment
Counselors do not use their places of employment or institutional affiliation to recruit clients, supervisors, or consultees for their private practices.
C.3.f. Promoting to Those Served
Counselors do not use counseling, teaching, training, or supervisory relationships to promote their products or training events in a manner that is deceptive or would exert undue influence on individuals who may be vulnerable. However, counselor educators may adopt textbooks they have authored for instructional purposes.
If you liked this post, consider reading this next. I think you'll like it ;) It's more about marketing your practice.
Jordan Harris, Ph.D., LMFT-S, LPC-S received his Doctor of Philosophy in Marriage and Family Therapy from the University of Louisiana Monroe. He is a licensed professional counselor and a licensed marriage and family therapist in the state of Arkansas, USA. In his clinical work he enjoys working with couples. He also runs a blog on deliberate practice for therapists and counselors at Jordanthecounselor.com