The Four Therapist Types: How Different Therapists Make or Break a Therapy Group Practice

Jordanthecounselor
Jul 7
6 min read

Four images of diverse pairs in conversation: an office, meeting room, park, and library. Warm interactions; people smiling and engaged.

I recently read Janse and colleagues' new article Disentangling the Therapist Effect: Clustering Therapists by Using Different Treatment Outcomes. In this article, they analyzed data from 68 Dutch therapists who saw 5,582 clients and found that there are four different types of therapists:

Group 1: The Referrers [1]- Approximately 13.43% of therapists demonstrated average client outcomes but also frequently referred clients for additional services. It's possible these clinicians were good for some, but also were aware enough of their weaknesses and knew when to refer out.
Group 2: The Talent - Approximately 22.39% of therapists were highly effective, as measured by client outcomes and client retention. This group had more young and inexperienced therapists. Which is strange. Why would the most effective therapists be younger and inexperienced? Likely because the younger and inexperienced were trying harder to improve their skills and meet clients where they were.
Group 3: The Ineffective - Approximately 25.37% of therapists were ineffective as measured on outcome surveys and client satisfaction surveys. This group tended to have older and more experienced therapists, likely because they'd stopped investing in their skills and stopped trying to improve as a counselor.
Group 4: The Mixed Baggers - Approximately 38.81% of therapists had a high number of clients dropping out early in therapy. However, for the clients who remained in therapy, they often had positive outcomes, even more positive than group 2 "The Talent". It's likely that this group is highly effective for some, but a big mismatch for other clients.

What This Means for Therapy Group Practices

On the one hand, this is one study and we shouldn't over generalize these findings. Still, these findings have huge potential impacts on therapy group practices.

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Track your KPIs

Our first recommendation is for group practice owners to track their own data. If you’re not tracking your KPIs (key performance indicators), you don’t have the information you need to make informed choices in your business. While Janse and colleagues conducted an academic study, group practice owners can totally track metrics like retention and how often clinicians refer out.

The most difficult metric to track is effectiveness. That might require purchasing a secondary system. I really like OQ-Measures. They have several systems I've used in the past. However, some EHRs are incorporating client surveys. For instance Simple Practice has a host of client outcome and satisfaction surveys it now offers for free.

Let go ineffective counselors

Second, the different types of therapists need to be handled very differently. From a group practice owner's viewpoint, clinicians falling into The Ineffective category (Group 3) will kill a practice. This group is hard to keep full, they take referrals from more productive clinicians, and they ruin your reputation in the community. It's likely that the best option is to make the hard decision to let them go.

Most of the time, group practice owners try to help these clinicians by encouraging them to get further training. However, research suggest that additional training does NOT help these clinicians improve. The reason is these clinicians are missing interpersonal skills [2] not interventions.

So while a master's program might teach a number of theories, and a certificate CE program might teach about a specific population, neither are teaching the interpersonal skills these ineffective clinicians are missing.

In Private Practice Incubator, the consulting firm Paul Peterson and I run, we do training in these interpersonal skills. But as far as we know, we're the only group which offers training in these skills. Reach out to us if you'd like the training, or take our mini skills test here.

Reach out to us!

Train the others

Finally, The Referrers (Group 1) and The Mixed Baggers (Group 4) therapists present a more nuanced challenge. For The Referrers (Group 1) therapists, who are "Good for Some" but refer out frequently, offering targeted training might be beneficial. This training should aim to broaden their skill set, enabling them to work effectively with a wider range of clients and retain them within the practice.

For The Mixed Baggers (Group 4) clinicians, the situation is more complex. While some in this group are clearly highly effective for those who stay, the high dropout rate needs investigation. This group could probably be divided into two subgroups: The Niche and the Wizards.

The Niche

The Niche are therapists who are super-effective for a specific niche but will repel other clients. You should probably offer them some sort of additional training on when to refer. Remember, trying to teach therapy skills is really hard, but if you help them to refer out sooner rather than have clients drop out, they might do better at meeting clients' needs, which will help your word-of-mouth referrals later down the line.

The Wizards

Some of these clinicians will be hyper-effective and people will stop coming back because they feel better so fast. Eri Vlass is like this. She would see clients for something like 5 sessions, and very often clients had massive gains between sessions 1 and 2.

The Wizards will likely have such strong word of mouth that their high rates of dropouts aren’t a problem. They bring in plenty of clients to cover their dropouts. But be careful. These clinicians are hyper-effective, which means they are rare. Unless you have data which shows this is you, don’t assume this is you.

Retention is Key to Group Therapy Practice Profitability.

The biggest lesson on all of this is on retention. The lifeblood of any practice is how many clients per week are seen in a practice. The two most important factors for how many clients are seen are:

How many people are calling your phone, ie the quality of your marketing.
How long clients stay in therapy, ie the quality of your counseling.

So if there's one lesson to take away, it's make sure you know your retention metrics.

Make sure you know how long your average client comes to therapy. Make sure you know the percentage of clients come for only one session. Make sure you know how many clients per month end therapy. All of these things are really important and will really help you run a better practice.

Best,

Jordan (the counselor)

Notes

[1] In the original article, they had different names for the four groups. I've changed the names to be slightly more catchy.

[2] A few references:

Anderson, T., & Strupp, H. H. (2014). Training in time-limited dynamic psychotherapy: A systematic comparison of pre- and post-training cases treated by one therapist. Psychotherapy Research, 25(5), 595–611. https://doi.org/10.1080/10503307.2014.935517
Janse P, Geurtzen N, Scappini A, Hutschemaekers G. Disentangling the Therapist Effect: Clustering Therapists by Using Different Treatment Outcomes. Adm Policy Ment Health. 2024 Sep;51(5):769-779. doi: 10.1007/s10488-024-01365-3. Epub 2024 Mar 21. PMID: 38512559; PMCID: PMC11379780.
Edmondstone, C., Pascual-Leone, A., Soucie, K., & Kramer, U. (2023). Therapist effects on outcome: Meaningful differences exist early in training. Training and Education in Professional Psychology, 17(2), 149–157. https://doi.org/10.1037/tep0000402

Jordan Harris and Paul Peterson are co-founders of Private Practice Incubator, a consulting firm dedicated to:

Helping clinicians earn more money.
Helping clinicians help more clients.

If you'd like to learn more about launching your practice, visit us here.

Jordan Harris

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

Paul Peterson

Paul Peterson is a Licensed Professional Counselor (LPC) and Licensed Marriage and Family Therapist (LMFT) in the state of Arkansas. He has certification and/or training in EFT, hypnotherapy, and mindfulness as well as adult psychological development models. He's been in the mental health field since 2015 and in 2019 worked with a team of authors to publish a content analysis in the Journal of Marital and Family Therapy. The content analysis reviewed almost 1,000 research articles and tracked trends in publishing and clinical effectiveness research. He has also published a book on a Wholeness-oriented approach to contemporary Christian faith. He gives regular training on clinical skills, hypnotherapy, and business skills for solo practice therapists.