Notes for New Therapists
A client asks to come every other week. Another cannot afford the copay. Someone ends therapy after two sessions.
You respect their decisions. You also do the arithmetic before they have left the room.
Perhaps you have a baby, a mortgage goal, or childcare for only three days a week. Perhaps you are paid only when a client attends. The fear is not imaginary. A fluctuating caseload makes it difficult to know what you can count on.
It is possible to care about your clients and be frightened about money at the same time. The trouble begins when the fear has nowhere to go except into the session.
Therapists can be worried and still do good work. No one is perfectly calm or financially secure before seeing a client.
But if you need a particular client to keep coming weekly, you may find yourself working harder than they are. You may explain one more time why therapy matters. You may hear their wish to come less often as a sign that you have failed. Or you may become so occupied with getting the session “right” that it is difficult to stay with what they are actually saying.
A client may not know why the conversation feels tense. They may simply feel less free to disagree, disappoint you, or say what they want. Even a client who could have worked well with you may decide the fit is not quite right.
A meta-analysis of the therapeutic relationship and outcomes in adult psychotherapy found a consistent association between the quality of that relationship and treatment outcomes. It does not tell us what happened with any individual client. It does give us a reason to notice what we bring into the relationship.
A client’s request for fewer sessions might raise a clinical question. You can explore whether the new frequency will support their goals. It may also raise a financial question for you.
Those are both real questions. They belong in different conversations.
The clinical question belongs with the client. The financial one may belong with a supervisor, consultant, practice owner, accountant, partner, or trusted colleague. It may require changing a contract, building a reserve, examining your fees, or looking honestly at whether the job can support your life.
None of that can be accomplished by persuading one client to keep an appointment they do not want or cannot afford.
It can help to know the numbers before the next cancellation arrives. What do you earn in a full week? What do you actually earn in an ordinary month? How much changes when several people miss or reduce sessions?
Those calculations may be unpleasant. They are also more useful on paper than as a running tally in the back of your mind while someone tells you about their marriage.
Talk with someone who can bear to hear the fear without dismissing it. “It will work out” may be kind, but it is not a business model. Neither is asking yourself to become so serene that an unstable income no longer matters.
You may need both emotional support and a more sustainable arrangement. The proportions will differ from therapist to therapist.
New therapists sometimes feel ashamed of wanting a house, time with a child, or an income they can plan around. As though being devoted to clients ought to make those needs disappear.
It does not.
A stable life may require changes in where, when, and how you work. Those decisions can take time, especially when licensure, supervision, family care, and money constrain your options. You do not have to solve them by next Tuesday.
For now, begin by owning the fear. It is understandable. It deserves attention. And when it has a place outside the therapy room, you may have more freedom to meet the person who is actually in front of you.
Anne Lindyberg, LMHC (Iowa), LCPC (Illinois), integrates the experiential therapy of Virginia Satir with Deep Brain Reorienting (DBR) and the Alexander Technique. She specializes in helping adults with complex and developmental trauma create lasting emotional change through therapy.
This article and other informational content on this website are provided for educational purposes only. They are not a substitute for individualized professional care, do not constitute advice specific to your circumstances, and do not establish a therapist-client relationship.
This work is created on the traditional and unceded lands of Indigenous peoples; a fuller acknowledgment of the land, its history, and its peoples is available on this website.
“The Alliance in Adult Psychotherapy: A Meta-analytic Synthesis.” 2018. https://pubmed.ncbi.nlm.nih.gov/29792475/
Midwest Center for Transformational Change PLC