The client engagement rate, also known as retention rate, is one of the key quality indicators that Rula uses to better understand the therapist-client relationship at Rula and is defined as the number of clients that successfully complete a second session with you.
But why is this so important? And what can you do if your retention rate does not reflect the quality care that you are providing? This article seeks to clarify why this number is instrumental to understanding how a therapist can facilitate the groundwork for an effective client-therapist relationship.
Why Client Engagement Matters
Client engagement (also known as “retention rate”) is not just about maintaining a full caseload- it directly impacts client outcomes. Research consistently shows that longer treatment duration leads to greater symptom improvement. A meta-analysis by Swift and Greenberg (2012) found a positive correlation between the number of attended sessions and symptom reduction, reinforcing the importance of keeping clients engaged beyond the initial session. Additionally, research indicates that clients report greater treatment satisfaction and meaningful progress when they feel strongly aligned and connected to their therapist (Flücchel et al., 2020).
With that said, client retention can still be very complex. Studies show that nearly 20-57% of clients drop out of therapy prematurely, often after the first or second session (Swift & Greenberg, 2012).
Barriers to consistent attendance roughly fall into one of two groups: 1) factors outside of the therapist’s influence and 2) factors within the therapist’s influence. Notably, the therapist’s role in addressing these factors with care and consideration often makes the difference between a client that remains engaged in care, versus one that discharges prematurely.
Factors outside of the therapist’s influence include:
- Financial accessibility (e.g. high deductibles)
- Previous poor experiences in therapy (e.g. “it doesn’t work for me”)
- Growing up in a culture that does not trust therapy
- Scheduling incompatibility (but maybe another Rula therapist may have more suitable availability?)
- A mismatch between the client’s needs and the therapist’s scope of competence
Factors within the therapist’s influence include:
- Fostering a warm, empathetic space for building rapport in the first session
- Creating a safer, collaborative healing environment
- A client’s readiness to change (e.g. utilizing motivational interviewing strategies)
- Inspiring hope in how the client may benefit from therapy
One of the strongest predictors of client engagement is the therapeutic alliance- the sense of collaboration, trust, and mutual understanding between therapist and client. Research suggests that clients who rate their therapeutic alliance highly, are significantly more likely to continue treatment. This highlights the significance of rapport-building from the very first session. While a strong therapeutic alliance is not built overnight, the foundation can be forged in an initial session.
Conversely, low engagement rates often signal misalignment in needs or expectations, a lack of perceived progress, or unspoken barriers to care. When clients do not feel heard, understood, or supported, they are more likely to disengage early. By recognizing and addressing these factors therapists can improve retention, enhance therapeutic outcomes, and ultimately help more clients achieve meaningful change.
Strategies to Improve Client Engagement
Below are a few steps you can take to improve client engagement and create a meaningful therapeutic experience:
Before Your Intake Appointment:
1. Leverage Your Therapist Profile for a Strong Start
Rula’s matching algorithm suggests therapists to clients based on a client’s preferred criteria. Via the Rula Therapist Profile, we strive to create a system where therapists can share in detail about their professional identity, their approach to care, and what a client can expect while in care with that therapist. This allows clients to choose someone who may be their ideal fit, with the intention of facilitating a strong therapeutic connection from the start. However, some clients ultimately disengage early because they feel their selected therapist isn't the right fit for their needs.
We strongly recommend therapists to reflect on their strengths as a therapist and who their ideal client might be, and to consider translating this to their marketing materials. You are welcome to partner with Rula’s Profiles team and your Provider Success Associate to regularly revise your Therapist Profile as needed. We also encourage you to check out our webinar with Megan Cornish, LCSW, who shared some of her tips and tricks for creating a stellar Therapist Profile.
2. Consider Outreaching the Client Prior to the First Session
Some Rula therapists choose to call or message the client through the Rula Provider Portal to briefly introduce themselves, welcome them to therapy, and provide words that reflect gratitude for being connected to the client. This can also be a great opportunity to review what one can expect in a first session, and to signal that an initial appointment is often not indicative of what ongoing sessions may be like. Given the significant fear and anxiety around starting therapy, clients often reflect appreciation for a friendly face!
During the Intake Appointment:
3. Normalize Conversations About Therapist Fit
It's essential to create a space where clients feel comfortable discussing their needs from a therapist. Ask open-ended questions like, "What qualities are important to you in a therapist?" or "How can I best support you in your therapy journey?" Normalizing these discussions empowers clients to express their expectations, which can strengthen the therapeutic alliance. Alternatively, this can also set the stage for facilitating a client-centered rematch, if needed.
4. Establish Clear Expectations Early
The first session sets the tone for engagement. Discuss therapy structure, potential challenges, informed consent, and realistic timelines for progress. Clients who understand the process are more likely to commit.
5. Prioritize the Relationship
A strong therapist-client relationship is critical to retention, so a great goal for the first session is to build rapport through information gathering. Simple actions- such as validating client concerns, demonstrating empathy, and collaboratively setting treatment plan goals- can foster trust and increase engagement. At the end of a session, therapists can also ask the client if there’s anything additional the client would like to add or address next time; this demonstrates that the client’s input is valuable and that they are co-creators in the therapy experience.
6. Address Barriers to Attendance
Clients often disengage due to logistical barriers or other perceived challenges. Discussing these obstacles early- and planning accordingly- can help improve consistency. Many clients benefit from having appointments the same day/time each week to help integrate therapy into their routine. Encouraging clients to schedule their next session before ending the current one can also increase follow-through.
7. Emphasize Early Wins
Clients are more likely to stay engaged if they perceive progress. Identify small, measurable improvements early in treatment and celebrate these to reinforce motivation. SMART (Specific, Measurable, Attainable, Relevant, Time-Bound) treatment goals and measurement-informed care tools like the GAD-7, PHQ-9, and C-SSRS can also clarify how the therapist and client are measuring progress. It can be very meaningful to a client with lifelong depressive symptoms to see their PHQ scores drop down by several points over a few sessions.
After Your Intake Appointment:
8. Consider a Post-Session Message
A brief message between sessions can reinforce commitment. Studies suggest that therapist-initiated follow-ups can reduce dropout rates (Simon et al., 2012). Depending on the therapist’s style, this may be a quick message expressing gratitude to the client for attending the appointment, reminding them about any homework, or offering them encouragement.
Client engagement is not just about numbers- it’s about ensuring clients receive the care they need to achieve meaningful change. By implementing the above strategies, you can enhance client outcomes, deepen the impact of your work, and create a sustainable practice that is fulfilling for all involved.
If you would like to examine your client engagement rate in greater depth alongside another clinician, we encourage you to attend a consultation session- the Quality team would love to support you!