Elana Sures 00:00
What I’ve really experienced firsthand is that when client retention improves, you have more oxygen, you have more money in the bank. But more importantly, you have happy therapists. You have clients who are getting what they came for. And then when your clients are getting great results, they become your marketing.

Linzy Bonham 00:21
They do.

Elana Sures 00:22
They tell their friends, and that’s the best scenario.

Linzy Bonham 00:31
Welcome to Money Skills for Therapists, the podcast that helps therapists and health practitioners in private practice go from money confusion and shame to calm, clarity, and confidence with their finances. If you’ve ever felt overwhelmed by numbers or avoided looking at your business money, you’re in the right place. I’m Linzy Bonham, therapist turned money coach and creator of Money Skills for Therapists. Before we jump in, I want to remind you of something really important.

Linzy Bonham 00:54
Most of us highly skilled and competent therapists and health practitioners were never taught about money, not in grad school, not in supervision, not anywhere. And yet, here we are running businesses that need to take care of us while we’re busy taking care of others. It is a lot of pressure. So if part of you feels anxious about money, avoidant, or like a bit of a hot mess financially, I want you to know that you are not alone and I am here to help.

Linzy Bonham 01:19
Through my workshops each month, I teach practical financial skills to help you feel more grounded, calm, and confident with your private practice money. You can see what’s coming up and save your spot to join live or register for the replay at moneyskillsfortherapists.com/workshops. Let’s get started.

Linzy Bonham 01:35
Hello and welcome back to the podcast. Today’s episode is with Elana Sures. Elana is a group practice owner in Vancouver, BC. She’s also a recent grad of Money Skills for Group Practice Owners, and just generally a deeply lovely human.

Linzy Bonham 01:52
And today, Elana is here talking about retention. We talk about retention from the perspective of group practice owners who are trying to support their team members to retain clients. But we also talk a lot about retention today in a way that’s gonna be completely relevant to those of you in solo practice thinking about what does a successful clinical relationship look like.

Linzy Bonham 02:16
We talk about how retention is about more than just how long somebody stays. We talk about the ingredients that Elana has identified that go into a clinical relationship to help to retain a client, have them stick around. And we talk about the importance of retention from a clinical perspective, that when folks reach out to us for help, they are looking to get the result.

Linzy Bonham 02:43
They’re looking to get to the finish line. And the way to get them to the finish line is to retain them, to have them stay on and actually do the healing that they have come to you to do. Here is my conversation with Elana Sures.

Linzy Bonham 03:03
So Elana, welcome to the podcast.

Elana Sures 03:04
Thank you, Linzy. It’s great to be here.

Linzy Bonham 03:06
I am so excited to have you here. So Elana, you just recently, like, I don’t know, a month ago, finished up Money Skills for Group Practice Owners. So I’ve had the privilege of working very closely with you for six months. But you’re here today to talk about this incredible work that you’re doing that I’m very excited ’cause it’s this beautiful complement to the work that I do in Money Skills for Group Practice Owners, which is you help therapists, group practice owners specifically, with retention.

Elana Sures 03:36
That’s right.

Linzy Bonham 03:37
So let’s talk about retention today, ’cause retention is actually, I’m gonna say for me, it’s a newer metric for me as someone who helps group practice owners with finances, so I’ve thought about the financial metrics a lot and help folks with the financial metrics. But this is a metric that I feel like was hiding in plain sight, um, ’cause I help folks think about like, okay, how many sessions a week are your clinicians seeing?

Linzy Bonham 04:01
What does that mean financially? What’s the number you wanna see? But I feel like retention is almost like a number that hides in that number. Like, in the number of folks who clinicians are seeing each week, there’s this other number, which is retention. So first of all, could you just tell us what retention means?

Elana Sures 04:18
Yeah. So to me, and I think practically speaking for, for practice owners to know, retention refers to the lifespan of a client. So it’s not just whether the client returns, it’s how frequently are they returning? At what intervals are they returning?

Elana Sures 04:41
How many sessions have they attended before they drop off or before they maybe start attending more sporadically? So it is historically has been a very difficult metric to put our finger on. It hides in the data, in the reporting data.

Elana Sures 05:03
Um, there are now some great ways of getting a better handle on that and calculating that, which I’m very excited about. But yeah, essentially it’s not that fancy. Client retention is the client’s journey in therapy.

Linzy Bonham 05:18
And the number that it measures, I think, is specifically like how long somebody stays. Correct?

Elana Sures 05:23
Yeah. So one of the most important levers is how many sessions has the client attended? And so what the research tells us is if we’re, if what we’re looking for is, is an outcome, which I think therapists of all stripes can agree that we want outcomes. We want our clients to get what they came for in therapy.

Elana Sures 05:46
We want them to stop suffering in the way that they are. And so what the research tells us is that a minimum of eight sessions, and personally, I find that very conservative, um, but that a minimum of eight sessions is required to attain the changes that are more sustainable, that are gonna actually show up in a meaningful way in the client’s life.

Elana Sures 06:16
So that’s one aspect of retention. Now, some… So what makes that tricky is a client can attend eight sessions in the course of a year. They can come once every six weeks, and that, that will look like they have, you know, this therapist has retained the client. They came there eight times.

Elana Sures 06:40
But the other thing the research tells us is that the intervals matter, that the therapy needs to be consistent. A client that’s coming sporadically or ad hoc is likely coming in a more reactive way. You know, they’re doing well, they stop coming. Something happens, they get in a fight with their boyfriend, or they go to a family dinner that was particularly tense, and they make an appointment with their therapist, and then the therapist doesn’t see them for a while after.

Elana Sures 07:08
And that’s not known to be a particularly effective way of conducting therapy, ’cause you’re just responding to a crisis. So the interval matters, and the other thing that is important to measure is how frequently are clients attending therapy? What cadence are they attending?

Linzy Bonham 07:27
Yes, because a successful clinical relationship is generally one in which folks are coming at a regular interval, not just responding to crisis. And yeah, there’s that, like, consistency. And if I think about when I was doing clinical work, working with clients, yeah, when we had that regular cadence, they’re coming at a regular pace, and some weeks something bad has happened, but another week we’re like, “Okay, let’s go back to what we were working on the week before.”

Linzy Bonham 07:51
That’s where you can really do that more depthful work.

Elana Sures 07:56
Yeah, and I think there’s a through line in good therapy. When there’s regular therapy, there’s this through line that adds this level of cohesiveness to the therapy. And that gives the work traction, but it also helps clients change. It helps them keep their eye on the prize and get through to the other side of whatever is the barrier standing in their way to the growth that they want.

Linzy Bonham 08:25
So for folks listening who are in solo practice, this obviously still applies to them because they also need to be thinking about how frequently are their folks coming, how long are they staying? Yeah, what is that cadence of therapy? Now, for people listening who are group practice owners, this is something that if they start to look at the numbers and realize that, oh, we have a bunch of clients coming but they’re not really staying for very long or they’re not coming often, this can be one of the metrics that group practice owners identify they might need to talk to their team about.

Elana Sures 09:00
Yes.

Linzy Bonham 09:01
Some conversations with the clinicians who are working with them about this. I’m curious, from your experience, why do group practice owners feel so uncomfortable having conversations around like retention with their team members?

Elana Sures 09:19
Great question. And they do feel uncomfortable. I coach a lot of group practice owners who exhibit tremendous discomfort and anxiety about having this conversation. Interestingly, what comes up again and again is this desire to not be seen as too corporate, like to not be seen as the establishment. They have this concern that by looking at these metrics and by talking about client retention, that they’re being too controlling, that they’re pulling rank and lording their power over their associates.

Elana Sures 10:00
Some of their concerns have to do with the structural model that they’re working under. If they have contractors, they’re concerned that it’s an overstep to look at deliverables, which it’s not. But more often it’s, it’s a leadership problem. It’s this internal barrier to having authority, showing authority, and saying, “These are my expectations, and I can support you in reaching them, but ultimately only you can make the adjustments necessary.” And so what I find really fascinating, Linzy, is it kind of parallels the discomfort that therapists have talking to their clients about “retention”.

Elana Sures 10:50
And we never use the word retention with clients. We don’t say, “You know what? I’m concerned about your retention.”

Linzy Bonham 10:57
Yeah.

Elana Sures 10:58
But where the concern shows up is in booking sessions in advance and proposing a cadence to the work and maybe following up with them if they’ve canceled a session and, and not rebooked. And so therapists typically have a lot of concern about showing up in that way for all the same reasons that I just outlined that group practice owners have showing up that way to their therapists.

Elana Sures 11:25
It’s about this concern around throwing power around.

Linzy Bonham 11:29
Yeah, I do think I see this a lot with, with therapists. I do see this a lot with group practice owners. And part of what I see is that often… Let’s talk about group practice owners first, and then I think there’s another piece here around the therapist level. But for group practice owners, often they have, like, a bad boss in their past

Elana Sures 11:52
Yeah.

Linzy Bonham 11:53
don’t wanna be that person, right? Or they have this idea of, like, the corporate asshole. Like, I remember one group practice owner I worked with a long time ago talking about working at, you know, like in a large hospital system in the United States, and the CEO getting up and trying to, like, be relatable and talking about his yacht vacation. And everybody’s like, “Fuck you.” Like, you know, like, who are just, like, so, um, out of touch with what their people are actually experiencing and, like, asking them to do things that they don’t know how to do.

Linzy Bonham 12:19
But even more broadly than that, I think that as therapists, we are really kinda, like, wary of power. You know, like, we don’t want to misuse power.

Elana Sures 12:29
Mm-hmm.

Linzy Bonham 12:30
Don’t wanna be oppressive. We don’t wanna be harmful. But in doing so, we’re not actually responsibly managing the power that we have anyways. No matter what, if you’re the boss, you have power. No matter what, if you’re a therapist, you have power in that relationship.

Elana Sures 12:47
Yeah. It’s, in a way, the elephant in the room, that there is a power imbalance. I like to really make a distinction between authority and power. So to me, I have authority. As a practice owner, I get to set the expectations for my practice. I get to decide what type of practice I wanna run, what values are important to me, and who I hire.

Elana Sures 13:17
But ultimately, the power to retain clients and book those multiple sessions and practice in a way that makes clients actually want to come back, really all of that power lies with the therapist and the client. And actually, I would argue, the client has the ultimate power. The client has the power to say, “Mm, no. Actually, I don’t wanna come back.

Elana Sures 13:40
I might even want a different therapist,” or, “I wanna come every two weeks.” And so there is this massive allergy, let’s say, to power. But ultimately, if we look at it as authority, and as a business owner, why, why would you be afraid of leaning into your authority? You’re bearing so much of the risk.

Elana Sures 14:04
You’re the one who’s staked so much of your intellectual capital, your visions, your money, all of that into this business. You deserve to have some authority.

Linzy Bonham 14:18
Yeah. It’s, it’s not undeserved.

Elana Sures 14:20
It’s not undeserved. And for the solo practice, uh, for the solo therapists who are listening, you’ve done all this training. You are the authority. You’ve done the research. You’ve worked with clients. You’ve seen these presentations before. You know that ad hoc therapy doesn’t work very well, and we’re fed this idea that the client is the expert and that a good therapist is anti-oppressive and anti-capitalist, and all of these things that are… You know, they sound good, and they sound very virtuous, but they’re not what we think they are.

Elana Sures 15:03
Showing our authority and really leaning into what we know and what we’ve trained to practice doesn’t equal lording power over a vulnerable person.

Linzy Bonham 15:16
Mm-hmm.

Elana Sures 15:17
This is what I believe quite strongly.

Linzy Bonham 15:20
We’re gonna dig into this for a sec, and then, you know, we’ll, we’ll get back to retention in a moment. But as you said, like, the client has the ultimate power in the relationship ’cause they’re the consumer. They can stop at any time. They can be like, “Nope, I’m not coming back.” They can choose not to show up to a session even. They don’t even have to tell you they’re not coming back. So they’re the one who gets to choose whether or not that relationship happens, right?

Linzy Bonham 15:42
The therapist can’t actually control that. But when they are entering into a therapeutic relationship, they are allowing this other person to have authority to help to guide them in healing that they can’t do on their own.

Elana Sures 15:56
Yeah.

Linzy Bonham 15:56
They’re basically consenting for you to guide them through a healing process that you are professionally trained to do, but at any time they can also walk away, right? So there is this interesting almost, like, exchanging of power or, like, giving of power. They’re giving you the authority to hold in that relationship, and they’re looking to you to tell them what they need to heal.

Elana Sures 16:20
They’re seeking our authority. They are aware that there’s an exchange. This is an atypical relationship. It’s an intimate relationship. They’re gonna tell you things that they haven’t told anybody else. They’re gonna trust you with things that they’re barely able to tolerate themselves. That is a very rare, beautiful, intimate relationship, and it’s a professional relationship.

Elana Sures 16:48
It’s an exchange of money for help, and the client knows that. They’re not showing up to therapy thinking, “I’m not gonna spend any money here.

Linzy Bonham 16:57
Yes.

Elana Sures 16:58
I’m gonna get help, but I don’t wanna spend any money.” They’ve made this calculus already. They’ve decided, “I’ve tried. I, I’ve listened to the podcasts. I’ve read the blogs. I’ve followed the influencers. I’m still suffering. I still find it hard to date and work and thrive and parent and do these things that I think should be easier for me than they are. I need help.

Elana Sures 17:21
I wanna pay for that help.”

Linzy Bonham 17:23
Mm-hmm. Mm-hmm. Yes. Yeah, they’re willingly entering into this exchange, and they can leave at any time. But, you know, coming back to the retention piece,

Elana Sures 17:35
Yeah.

Linzy Bonham 17:36
I’m curious, like, how do you see therapists often think about or try to manage retention?

Elana Sures 17:43
What I often see is the therapist leaving it up to the client. So a session will end, and the therapist will say, “You know how to find me. You’ve got my booking link. Come back when you feel like it.” That is what I often hear.

Elana Sures 18:05
I can even tell you that in my earlier days of private practice, that was absolutely how I operated until, until I had a client who said to me at the end of the session, she was very direct, “Elana, do you want to see me?” And I was like, uh, “Of course I wanna see you.” And she said, “‘Cause I feel like at the end of our sessions, you’re kinda like, ‘Okay, bye.

Elana Sures 18:30
See ya. See ya when I see ya.’ And I, I think maybe, maybe you have other people who need to see you more than me, or maybe you’re too busy.” And oh my gosh, that was a pivotal moment for me. I had never thought about what it means to clients to just sort of be left adrift at the end of the session.

Elana Sures 18:57
Client retention is a container. It’s a client-centered retainer. And so it’s not… Like when we think about client retention maybe in a different industry, it, it can, it is a lot more salesy and it is a lot more, you know, you know, follow-up emails, like, you know, those blitz of follow-up emails and texts and phone calls.

Linzy Bonham 19:19
Yes.

Elana Sures 19:20
In our industry, client retention is this container where it’s actually the most relational and client-centered thing we can do to say, “Look, I see you. I get how you’re suffering, and I think I understand why you’re suffering, and I can help. But I can only help you if you show up.

Linzy Bonham 19:42
Mm-hmm.

Elana Sures 19:43
Let’s get that sorted. Let’s get some appointments on the books.” And it goes beyond the booking. Honestly, I hear so many, um, people talk about client retention as though it’s just booking. Really, at the point where you’re proposing that the client should book more sessions, the work, the heavy lifting has already been done. Like, the relational trust, the treatment plan, the vision for therapy and the path forward, that’s already been shared and established with the client so that they want to book.

Elana Sures 20:17
It’s a no-brainer for them to book.

Linzy Bonham 20:20
Right, so the booking is just the final piece.

Elana Sures 20:22
The booking is just the logistical piece that gets them in your, in your calendar.

Linzy Bonham 20:27
Yes. Yes. I mean, it occurs to me when you mention that client being like, you know, “Do you wanna see me?” Like, “Do other people need you more?” Just how much when we’re relationally kind of like hazy in the therapeutic relationship, it opens up space for them to run all of their stories.

Elana Sures 20:43
All of the stories.

Linzy Bonham 20:44
it is for them, “My therapist doesn’t really like me. My problems aren’t real. Other people need more help. I’m boring. Yeah, like everybody will have their own story that can be activated if they have reason to think that their therapist doesn’t really wanna see them again.

Elana Sures 20:58
Yeah, and therapists are so concerned with being too controlling and having too much of an agenda and working in their own self-interest that they’re projecting something quite different. They’re projecting that my client is going to experience me as controlling and authoritarian or, or something like that if I take leadership, if I show leadership in the session.

Elana Sures 21:26
And we really need to decouple that. We really need to decouple this idea of being controlling as the same as showing leadership and some authority. You know, most therapists, I would hope almost all therapists, know the difference between showing authority in a way that is gonna be really triggering to a client versus showing leadership in a way that presents themself as a solid, safe container and presents therapy as a professional enterprise in which good work gets done and helps people change.

Linzy Bonham 22:13
Yes. Yes. ‘Cause I mean, if you were gonna describe the ingredients for retention, I feel like you, you, you talked about them briefly, but like I almost wanna think like if we were gonna make a retention soup,

Elana Sures 22:24
Mm-hmm.

Linzy Bonham 22:26
That you see that all come together to result in clients being retained and staying on and actually doing the work that they’ve come to you to do?

Elana Sures 22:34
Mm-hmm. Well, in my program, I distill it into the four C’s, uh, because I really like easy-to-remember things. So the first C is confidence. That is, I believe, I trust myself as a therapist. I am listening to the client, I’m attuning to them, and I trust that I can help them and that I can adequately, not just adequately, that I can tap into what the work is that they need to do and help them get there.

Linzy Bonham 23:09
Mm-hmm. Mm-hmm. No.

Elana Sures 23:14
And tentativeness does not project that confidence. The second C is collaborative. So I’m listening to them, I’m attuned, but I actually need to constantly be checking in, uh, with them about what I’m hearing, my observations, my impressions, and how that aligns with what their lived experience is.

Elana Sures 23:42
And that collaboration is what helps us come up with a treatment plan that’s, like, super tight and meaningful. And so a therapist cannot do this in isolation, no matter how much training they’ve had. So the collaboration comes in the setting, the therapeutic agenda. What are we here to work

Linzy Bonham 24:04
Mm, no.

Elana Sures 24:09
is cohesiveness. It’s really easy as a therapist to get kind of pulled in different directions because clients don’t have a playbook for coming to therapy. They, they don’t have this set of, “Okay, you must only… now that we’ve determined that a, a fear of intimacy and avoidant attachment are your issues, you must only talk about things that relate to that.”

Elana Sures 24:32
So they come, they’ve maybe just gotten into a fight with their roommate, or maybe they’re really stressed about an exam. So they’re all over the place. We provide the through line. So we apply what we know about them, to say, “Hey, I hear you really stressing out about this, and you know how I see that as fitting in with these core issues that we’ve already been talking about?”

Elana Sures 24:57
So we are constantly taking in all this new information and fitting it in with this core

Linzy Bonham 25:05
Hmm.

Elana Sures 25:06
of issues. Because otherwise, we’re just kind of an advice-giving machine, and it, it, it doesn’t feel grounding for a client to be in that mill. And the fourth C, and this is not fourth because it’s the least important, is curiosity. I wanna be so curious about how this person came to have the issues they have. And why does curiosity lead to better retention?

Elana Sures 25:35
Because a client can feel our fascination with them, and it makes them feel known. Clients wanna feel known. They feel so performative in so many other aspects of their life. Many of them truly are experiencing disconnection, and so they’re showing up, they’re masking, they’re people-pleasing. They’re behaving in ways that they think they ought to be behaving.

Elana Sures 26:02
And when we can leverage this curiosity, our confidence, all of these C’s that I’ve just sprinkled around, we are getting closer and closer to knowing who they are and to them knowing who they are. And that is… Honestly, that is really the heartbeat of client retention, to feel known and understood, and to be able to use that self-knowledge and that relational connection as a starting point for doing some complicated work.

Elana Sures 26:37
People want to come back when they feel like they’re coming back to somebody who truly gets them. And in a way, client retention is really, a big part of it is just about getting your shit together as a therapist, really.

Linzy Bonham 26:54
Yeah. ‘Cause everything you’re describing to me gives me the sense of groundedness. There’s a container, there’s being held, there’s being heard. It’s just building a very solid therapeutic relationship with somebody. And the cohesiveness is interesting ’cause I think… I’m thinking back to an email that I got probably sometime in the last year from an old client of mine.

Linzy Bonham 27:20
I haven’t practiced therapy in about five years. But she sent me a random email out of the blue just being like, “Hey, thinking about you. You know, still, still so appreciate the work that we did together.” Um, you know, and I, I replied. Oh, and said, “I, I’ve never really found anybody like you since I worked with you,” which like, you know, as a former therapist was kind of like, ugh, guilt pang. Like wah.

Linzy Bonham 27:42
You know? Um, and when I replied, I just said, you know, “I’m so sorry to hear you haven’t found somebody. Here’s a list of like colleagues, folks like…” I, I was like, okay, here we’re in a referral situation. I’m gonna like give her a great referral. And then she replied, and she was like, “No, no, I have a great therapist. It’s just she’s not as effective as you were. We don’t get down to the work. And if I think about the way that I used to work as a therapist is like, yeah, somebody might come in, and their, their son-in-law is being an asshole, and like that’s frustrating ’cause it’s impacting their relationship with their daughter, and there’s always like new fodder.

Linzy Bonham 28:12
But I would always, as you say, bring that back to like why we’re here, which I was a trauma therapist, so it’s like, okay, yeah, I’m hearing that, and I think once we work on this trauma piece that we were working on last week, that this is gonna come down. And I always brought folks back to the work. Like not treating them like they’re fragile, not getting kind of like distracted, but like both hearing and validating and being with and then being like, you know, “Do you wanna spend time on this?

Linzy Bonham 28:34
Do you, or should we continue with this work?” And just how grounding that is for people to have somebody to both hear them, but also bring them back to the bigger picture, the reason they actually came to therapy, which is not to talk about their son-in-law being a dick last week. And just how effective that is over time when we can hold our authority and remember why they’re really here, and like what plan we set together and what they’re actually looking for from therapy, which is not, as you say, like a rent-a-friend.

Linzy Bonham 28:59
You didn’t say that, but that phrase always comes to mind for me. You know, they could just bitch to their friend over coffee if they just wanna like have somebody be like, “Ah, what a jerk.” You know, they’re, they’re coming… In my case, they were coming for trauma reprocessing, which they can’t get from anywhere else in their life. So that’s an incredibly valuable project that we have committed to together that, you know, we kept coming back to.

Elana Sures 29:21
And you know what’s interesting, given that this is a money skills podcast, I wanna share a bit of a hypothesis that I have about why, why therapists sometimes don’t come back to the through line or, or why they forget to be cohesive. And in my years of providing clinical supervision and overseeing a team, what I hear over and over is therapists confessing to me that they want to give this client their money’s worth.

Elana Sures 29:57
And so when a client comes in, spun about the son-in-law that’s an asshole or the latest whatever, we kind of jump up and down. You know?

Elana Sures 30:11
We’re, we’re like, “Okay, I can do that. I can help with that. Let’s do this.” I need to, I need to prove to you that this session is gonna be worth your 175 bucks or whatever it is they’re paying. So a part of my program and a part of me coaching people on client retention does come back to how do you feel about charging people money when they come to therapy?

Elana Sures 30:39
Because that is going to influence our relationship to leadership and authority.

Linzy Bonham 30:45
Yes. Yes. Yeah, I’m thinking about the, uh, if there’s anxiety around charging money or guilt, how that could kind of like get us out of our groundedness or…

Elana Sures 30:58
the self-worth issue too about, you know, how do I prove myself worthy of this client’s money and time? Whereas what you and I are suggesting is that that deeper level of attunement and sturdiness and direction really is a huge part of what clients are looking for.

Elana Sures 31:23
They feel so messy inside.

Linzy Bonham 31:26
Mm-hmm. Yeah, absolutely. And Elana, I’m curious, like when individual therapists and also practice owners, ’cause you, you work with group practice owners helping them support their therapists, so you’re kind of working with, you know, this, this extra level of the folks who do actually look at their therapist numbers and see, okay, there’s, there’s something here.

Linzy Bonham 31:48
So I’m curious on both levels, ’cause some folks listening I know are gonna be solo practitioners who are thinking about their own practice. Other folks are gonna be group practice owners thinking about how to support their team with this.

Elana Sures 31:55
Mm-hmm.

Linzy Bonham 31:56
What do you see happens when folks start prioritizing retention? What, what is the impact of that on their practice?

Elana Sures 32:06
I’m gonna answer that question both as a group practice owner and as a therapist. So the impact on therapists when they start prioritizing client retention is that they find the work more rewarding. They’re seeing clients through incredibly important pieces of work. They’re finishing the work.

Elana Sures 32:31
They’re seeing progress and change. They also have a lot more stability. They can look at their weekly calendar and see that these are mostly returning clients. I know exactly what we’re working on. It’s not this turnstile of new clients and people who are kind of popping up after two months, and they don’t really remember what they were coming for in the first place.

Elana Sures 32:57
There’s a certain stability and groundedness to the work that ultimately prevents burnout. From the practice owner perspective, it gives an enormous amount of stability to the practice, um, when clients are returning. From a financial perspective, absolutely. What I hear over and over in the practice owners I speak to is they’re always talking about marketing and how much money they should be spending on marketing and their Google Ad spend.

Elana Sures 33:32
“Should I, should I spend more on Google Ads? I feel like we need more leads. I, I wanna hire, but for whatever reason, I’m having trouble keeping people full, and maybe if I just had more leads, and it’s like more leads, that’s the thing that everybody’s talking about. Should I do SEO in addition? Like maybe I should hire a social media person and, and just bring in more people. And not only is that exhausting, but it’s very expensive.

Elana Sures 34:02
You know, Google Ads in our industry, particularly if you live in a city, in the city where I practice, Vancouver, Google Ads are

Linzy Bonham 34:13
Particularly Vancouver, yes.

Elana Sures 34:15
exorbitantly expensive. Social media managers, they don’t do this for peanuts. So if we’re constantly focused on just getting bums in seats and then like bringing in new leads, that’s going to be very costly. It’s going to be a huge operational expenditure, and ultimately is going to eat into your profit margin.

Elana Sures 34:43
And what I also see is that, if a practice owner isn’t on top of retention, if they’re not tracking it, paying attention to it, then this leaking can happen for months and months, where they look at their calendar on their EHR, and everybody looks busy. The calendar’s full, but the money is not flowing. At the end of the month after payroll and after the Visa bill gets reconciled, there is very little money left, and that’s very anxiety-provoking, and it’s also not very responsible business ownership.

Elana Sures 35:23
So what I’ve really experienced firsthand is that when client retention improves, you have more oxygen, you have more money in the bank. But more importantly, you have happy therapists. You have clients who are getting what they came for. And then when your clients are getting great results, they become your marketing.

Linzy Bonham 35:46
They do.

Elana Sures 35:47
They tell their friends, and that’s the best scenario. So it is… I don’t know why any practice owner would not be obsessed with client retention. It is from all angles. If you care about clients, if you care about your reputation in the community, and if you care about running a profitable business, it is as important as marketing.

Linzy Bonham 36:10
Yes, agreed. I mean, in business, it’s a truism that acquiring a new lead is always the hardest and most expensive thing to do, right? You’re always much better holding onto somebody who’s already found you. ‘Cause like think of all the energy you’ve put into being found, and then the process that they went through individually as a person to be like, “Okay, I see this practice. Am I gonna reach out?

Linzy Bonham 36:31
I don’t know. Maybe I’ll do it tomorrow.” You know, like how almost like much energy they’ve put in to coming to contact you. Like there’s just so much money and energy that’s almost been like burned for that person to get there, that then to lose them like two weeks later when they came to work on their childhood abuse for the very first time in their life, and then they get a clinician who’s like, “Well, you know, like you, you know where to find me.”

Linzy Bonham 36:56
And they’re like, “Oh, yeah, maybe she can’t really help me. Maybe I’m too fucked up. Maybe she thinks I’m the craziest person she ever saw,” and they don’t call back again. It’s like all of that energy and money is now wasted, and also this, this client, this person who really needed help. And finally… And I feel emotion in myself talking about it ’cause it’s just like I’m thinking of moments in my life where I’ve been like, “Okay, this particular thing has come to a head,” like I’m finally gonna reach out.

Linzy Bonham 37:23
It’s… there’s just so much charge in that.

Elana Sures 37:27
Yeah.

Linzy Bonham 37:28
To have them then not actually get help and go back to being like, “Well, I tried therapy. It didn’t work,” it’s so

Elana Sures 37:37
And it is so tragic. It, it actually breaks my heart thinking about this right now. Like, there are not enough words to convey to you sitting on this call how upsetting I find that idea that a client shows up to therapy wanting help and leaves feeling like, “What is the path forward exactly?”

Linzy Bonham 38:01
And this is… I’m really happy that this conversation today is going to apply to literally every person listening to this podcast, because if you’re in solo practice, you also, you know, this is how you also have a thriving solo practice, right? Is like hold onto your folks, you know, show them that you can help them. Give them that cohesiveness. Set a, set a schedule with them, and that can be collaboratively, right?

Linzy Bonham 38:25
Like when I was a therapist, it was like, okay, what makes sense? You know, we could do weekly. Does weekly make sense for you? Bi-weekly? But it’s like we set a cadence that makes sense for them collaboratively. We’re not saying you have to come every week or you’re not gonna get better. Oh, you can’t afford that? Mm, guess you’re never gonna get better. But it’s just so important that we create that container, that the folks who come because they want our help actually stay and get the help that they came for.

Elana Sures 38:52
Yes. And I want to emphasize something that I hear a lot, which is clients come to therapy and they only have a certain amount of benefits.

Elana Sures 39:06
I’m Canadian, so extended health benefits. In the US, it might be insurance coverage. Um, and that is true. Some, some benefits cover more therapy than other benefits. But what I’ve observed in my team, and I have a fairly large team, 20 therapists, is that’s not the reason people leave therapy early. There are clients who go far beyond their benefits because they’re getting results, because they’ve done the calculus.

Elana Sures 39:38
They’ve, they’ve realized that the cost of not being in therapy is greater than the cost of being in therapy. And yes, there are some clients who will only come until their benefits run out. But I see people again and again extending their stay in therapy, not because their therapist is exploitative, but because they want to, they want to finish the treatment.

Elana Sures 40:03
They want to get where they need to get to before they taper off.

Linzy Bonham 40:08
Yes. Yeah, and in Canada, you know, some folks listening are gonna be in Canada, some in the United States, some around the world. But I will say in the Canadian context, extended healthcare benefits are usually not that much money. Like, I have $500 a year for therapy. You can imagine how quickly that disappears. So in Canada, kind of the default is that folks are paying out of pocket. You know, once you get past whatever that amount is, I, I know only literally one person who has $10,000 of coverage.

Linzy Bonham 40:35
She works for a university. Professors go on strike a lot. They’ve won some good benefits for themselves. But for the rest of us, therapy is something that you are mostly paying out of pocket, but folks still stick around for months and years when their needs are being met.

Elana Sures 40:54
Especially now, I feel like the way younger people in particular are thinking about therapy is very different from a generation ago, even my generation. I don’t want to say how old I am, but, you know, old enough so that literally none of my friends went to therapy until maybe, you know, until maybe 10 years ago, 20 years ago.

Elana Sures 41:23
Okay, I’m outing myself. But my point here is a lot of people really value therapy now. We’ve gone through this shift, in which people are really unapologetic about wanting and needing therapy and, and spending money on it and making it a priority. And I think therapists need to trust their clients, that their clients know what’s best for them.

Elana Sures 41:51
If a client is showing up to a session or a free consultation, that’s a warm lead. You’re not exploiting them by saying how you can help them and what type of commitment will optimize their experience in therapy and translate to shifts in real life.

Linzy Bonham 42:12
Mm-hmm. Yes. Yes. And I would say that’s a hot lead by the

Elana Sures 42:16
A hot lead. Yeah.

Linzy Bonham 42:18
Again, all of the kind of like decisions that they’ve made and the, the steps that they have taken to get to that point that they’re actually sitting with you in your office.

Elana Sures 42:28
But some people treat them as kind of lukewarm leads, right? And, and including group practice owners. Group practice owners sometimes get co-opted into this way of thinking about client retention as it’s up to the client.

Elana Sures 42:49
Only the client can decide if they’re going to come back. No. Therapists, in my experience, with the right tools and the right prompts and some shifts to their mindset can really rise to the occasion and make a measurable difference in their retention.

Linzy Bonham 43:12
Yes. And then to dovetail this into money and money skills,

Elana Sures 43:17
Yes.

Linzy Bonham 43:19
What do you see as the impact financially on practices where this is being prioritized?

Elana Sures 43:26
The first thing I notice is an increase in profit margin. Increase in revenue, but also an increase in profit margin, ’cause as you know, you can have a ton of revenue, but very little profit.

Linzy Bonham 43:38
I do know that, yeah.

Elana Sures 43:39
Yes. Uh, so an increase in revenue, yes, but also constantly pumping that marketing gas isn’t as necessary. So that doesn’t mean that you completely stop marketing, but it might mean that you’re not throwing spaghetti at the wall with your marketing.

Elana Sures 44:01
Or it might mean that you’re actually, and I’ve done this, gradually reducing your ad spend, your Google Ad spend, or dropping your SEO because it’s not really as necessary.

Elana Sures 44:14
You’re getting repeat clients who are referring their friends. So the easiest thing to measure is profit margin. And it doesn’t happen overnight. I would say I would give it six months of really working with your team, um, making this a priority, having quarterly meetings, uh, like measuring what needs to be measured and monitoring it, and seeing what types of shifts are happening, both in the practice overall, but also with each individual therapist, because some therapists will need more support than others.

Linzy Bonham 44:58
Mm-hmm. Yes. Yeah. Elana, it’s been so lovely having you here today.

Elana Sures 45:04
This was fun, truly.

Linzy Bonham 45:08
And I do have one question for you before we start to wrap up. Having just finished up with Money Skills for Group Practice Owners program,

Elana Sures 45:17
Yeah.

Linzy Bonham 45:18
I’m curious for you, when you were thinking about joining that course, like what tipped you over into joining and, and how was that experience for you? Just thinking of the, the group practice owners who are listening now.

Elana Sures 45:32
Yeah. For me, I have historically been a master eyeballer of things, which sometimes is a wonderful skill to have.

Elana Sures 45:47
But it turns out when it comes to the financial wellbeing of your business, eyeballing is not a recipe for success. I really struggle with things like spreadsheets. I find I’m quite avoidant with money sometimes, so even though I knew that QuickBooks was out there somewhere, I never really checked it.

Elana Sures 46:12
I paid a bookkeeper. I still do pay a bookkeeper, by

Linzy Bonham 46:15
Mm-hmm. Yep.

Elana Sures 46:17
Yes. So I had heard from other people who had taken your course that I would no longer allow myself to eyeball things and just kind of guesstimate once you were done with me. And I felt that that was really the next step for me. My practice was successful, um, but I felt this nebulous kind of fuzz ball around money.

Elana Sures 46:45
All I knew was that it was moving in the right direction, but it was really hard to make decisions about hiring, about giving my clinic manager a raise. I didn’t really know how to make decisions like this, and so I would just sort of wing it, and that was starting to scare me as my practice grew and became bigger and more people were relying on me.

Elana Sures 47:08
And that’s what tipped me over the edge, was this idea that somebody could help me be less flaky about the money part of things.

Linzy Bonham 47:19
Yes. And I think you are an excellent example of a really successful group practice owner who has tons of confidence and got really, really far without building out this skill set specifically. But then you get to the point where you’re like, “Oh shit, this is really big now.” And like, you know, there’s, there’s a lot of risk and liability as we get something bigger and we don’t really understand why it’s working and what would make it stop working.

Elana Sures 47:46
Yes. That pretty much sums it up actually. So, and I just finished your course last month, and I have a skill set that I could not in any world have come up with on my own.

Linzy Bonham 48:04
Hmm. Yes.

Elana Sures 48:05
I sometimes curse you when I’m filling out those spreadsheets, but I am always better off for having done it.

Linzy Bonham 48:12
Yeah. Um, Steph Davis and, and Laura Bull, who I think you, you know, um, Steph told me that her and Laura, when they’re making decisions for their business, will ask themselves like, “What would Linzy say if she was here?” And they said, she said, sometimes they’re like, “Nah, fuck Linzy. We’re gonna do it anyways.” And I was like, “Oh, okay.” But more often than not, they’re like, “Yeah, okay.

Linzy Bonham 48:35
Are we making an emotional decision right now? What’s actually driving this decision?” So it’s, yeah, it’s just giving you that extra skill set that you could dig into to actually look at the numbers from a really literate, balanced, grounded place.

Elana Sures 48:51
Yeah, literate is the right word. I feel very… My financial literacy is in an entirely different place than it was six months ago. It’s really like night and day.

Linzy Bonham 49:03
Thank you for sharing that, Elana. Now, for folks listening, you can obviously tell that Elana is so wonderful. For folks who are specifically group practice owners who want to be able to, like, understand these numbers and support their team, where can they find you? Where can they get more from you?

Elana Sures 49:21
If you are a group practice owner, I would love to have you in my Facebook group. It’s a growing group of very smart, dedicated, interesting group practice owners. The link will be in the show notes, but you can also look it up. It’s called The High Performing Practice.

Linzy Bonham 49:44
Beautiful.

Elana Sures 49:45
and we talk about all of these things in that group. You can also look at my website, grouppracticeperformance.com.

Linzy Bonham 49:56
Okay. Thank you so much for joining me today, Elana. It’s been so fun having this conversation with you.

Elana Sures 50:00
Yeah. Thank you for having me. It’s been a true pleasure.

Linzy Bonham 50:06
I really appreciate Elana coming onto the podcast today to talk to us about retention. And something that I’m really struck by is how retention is, of course, important for profitability in order for your business to be healthy. Obviously, the folks who come to see you need to come more than once. It helps if they come regularly.

Linzy Bonham 50:29
But also how retention in so many ways is actually kind of the heart of the clinical relationship, whatever that retention means. You know, if you are doing more short-term therapy with folks, whether that’s mental health therapy or treatment that you know that it takes six sessions for somebody to get results, then that would be your measure, is if somebody comes consistently for those six sessions, you know that you’ve had this time and space to get them to the finish line.

Linzy Bonham 50:57
But if you’re doing, you know, long-term therapy with folks, if you’re doing depth therapy like the type of therapy I used to do with folks of complex trauma and dissociation, they needed to come probably at least 12 times before we’re really starting to move the needle to get them to that more, I wanna say holistic. That’s not quite the right word, but usually we had a whole list of things that they were working through in terms of EMDR targets, meaning specific traumas that they wanted to no longer have interfering with their life.

Linzy Bonham 51:29
And that’s not work that we could do successfully in four sessions. That was at least 12, if not 20, maybe 30, depending on the scope of the work that they were doing. So retention is important to have a healthy practice financially, but it’s also very important to have a healthy practice from an effectiveness standpoint and to actually deliver what your clients are coming for.

Linzy Bonham 51:55
So I’m so grateful to Elana for coming on the podcast today to get our wheels turning around retention.

Linzy Bonham 52:01
And if you are a group practice owner in the BC area, meaning British Columbia, Canada, so Pacific Northwest for those of you in the US, I wanna let you know about a meetup and workshop that we are doing in person in British Columbia on August 15th. So it is coming up real soon for those of you listening when this episode has just come out.

Linzy Bonham 52:23
But we are doing our first ever, I believe, live event for Money Skills for Therapists. This is a group practice owner event. It is our meetup and workshop for BC group practice owners. We are going to be creating the space for BC group practice owners to meet. You might meet folks in person that you’ve only ever seen online in Facebook groups or maybe taking courses with before.

Linzy Bonham 52:47
I’m gonna be teaching an interactive workshop about how to make grounded financial decisions as a group practice owner. How do we balance our values and our feelings with the numbers to help us actually make our group practices sustainable? We’re gonna have a panel of group practice owners, including Elana. She’s gonna be one of our participants, along with Steph Davis of Shoreland Counseling and Stephanie Iverson from New Ground Wellness talking about how they as group practice owners balance their values and numbers when they are leading their team.

Linzy Bonham 53:22
There’s gonna be food, there’s gonna be drinks, it’s gonna be really nice, and the event is only 30 bucks. So it’s a great deal. You can go to the link in the show notes to register for our BC meetup and workshop. Just reminding folks who are down in Washington, it’s not a far drive. You should just zip on up past the border, or folks in Alberta just, you know, come over the mountains. If you are listening to this and August 15th is long in the past, then I would encourage you to check out the Money Skills for Group Practice Owners program, the program that Elana and I were just chatting about.

Linzy Bonham 53:55
If you go to our website, you can look at courses, look up Money Skills for Group Practice Owners. That is our six-month program where we help group practice owners, even really successful group practice owners who have figured out a lot. We help you actually understand the money part of being a group practice owner and help you be an empowered financial leader. Thank you so much for joining me today.