Too few? Too many? Too little? Too much?
A news story which grabbed me last week was Microsoft buying Activision the video games company for $75bn.
Before I read this story I was thinking about what I would write about in my first blog of 2022.
One of the questions which supervisees put to me is about the number of clients they should work with in private practice. In other words what constitutes a manageable, viable and fulfilling case load.
One Friday afternoon some time ago I was working with a colleague who told me she was feeling exhausted. I asked her how many clients she had seen that week and her answer pretty much blew me away. She had seen 37 people that week each for 50 minutes. I wondered how she was able to function with such a huge case load and what it was like to be her 37th client late on a Friday afternoon. Too many?
More recently I was contacted by a qualified therapist looking for supervision. One of my questions was about the size of her case load and she responded that she was seeing 3 clients. Too few?
It must be clear to any experienced therapist working in our profession’s usual 50 minute sessional time block that a case load of 37 people is too much. But why?
What is sometimes forgotten by both practitioners and clients is that our fee covers not only the 50 minute session time but also the time we spend in preparation before a session and the time we spend making notes afterwards.
Plus, of course, there is supervision time, a minimum of 1.5 hrs a month. With a case load of 37 clients I would have expected that particular therapist to have had far more than a mere 1.5 hrs a month. But there’s another factor too …
Has a client ever popped into your mind when you’re in the shower, surfing the web, or on a run? I know this happens to me.
Our clients are ‘renting’ some of our headspace. Freud used to take his clients on holiday with him together with his family! Today such behaviour would be considered unethical but in Freud’s day it was thought to be OK. Times change, ideas move on. But 37 clients is a heck of a lot of clients to be accompanying you, not on your holiday but in your head. Too many?
So what about 3 clients, surely that must be OK? Well in my opinion 3 clients is too fewand the reason for this is that 3 clients can also occupy too much headspace, too muchof our focus and attention.
There’s yet another consideration. In my opinion a private therapy practice should be financially viable. No one becomes a therapist to get rich. There are much better ways of making money – like selling your games business to Microsoft for $75bn. Making a lot of money is not the reason we become therapists
Having said that, I believe that being a therapist is not a hobby and the fees earned from seeing only 3 clients a week are too little to support a financially viable practice.
I can hear you asking ‘OK, so what’s the right number of clients for me to see?’. My answer is it depends…
For example, it depends on whether you are seeing individuals or couples. Do you work in person or online because I think that online work is more demanding for the therapist. How many days a week do you work? What is the nature of your work, for example, do you see clients with PTSD or personality disorders?
OK, so here are my ideal numbers …
In my view an ideal minimum number of clients in private practice should be about 10 and an ideal maximum not more than 25. For some of my supervisees a comfortable number is between 15 and 20 clients a week.
As the Americans say ‘Do the math’. At an average fee with an average number of clients working an average number of weeks per year, a case load such as this produces a gross income of around £50k per year. That’s a heck of a lot less that the $75bn which Microsoft paid for Activision last week.
$75bn for a games company? Too much? £50k a year for a therapist? Too Little?
I’d love to hear your thoughts.
Do you resonate with this topic?
If so, get in touch to see how I can help you today.