Client satisfaction in therapy

Client satisfaction in counseling is one of those concepts counselors may consider, but may have questions around how to improve it. As therapists, we want to help our clients make changes in their lives that ultimately lead to an improved quality of life. But, does this goal result in greater client satisfaction with our services?

Client satisfaction remains a desired outcome for most health care and mental health care providers. Clients may feel more satisfied with our services when the counseling experience meets their expectations for counseling and aligns with their values.

When clients have greater satisfaction, they will more likely:

• Seek out therapy when needed
• Engage with the therapist in the session
• Comply with treatment
• Maintain an ongoing relationship with the therapist for the duration of treatment

In this article, we will explore how a practice can work toward improving client satisfaction.

Understanding client expectations

Because client satisfaction can be linked to client expectations for treatment, it is important to begin the therapeutic relationship by identifying and discussing these needs and expectations. This process should be a standard component of the intake and assessment process. 

Identifying client needs for treatment can begin with the intake paperwork. Your paperwork can include questionnaires, quizzes, or assessment tools for your client to complete before the intake session. These various forms can help you and your client identify treatment needs. You can tailor the tools you select to the niche or population that you treat.

You can collect additional information from the client regarding their treatment needs and expectations for counseling during the first few appointments. You can follow up on this initial discussion in future sessions by exploring the client’s progress in treatment. 

During the assessment process and treatment planning sessions, you can ask the client open-ended questions to initiate discussion regarding the client’s expectations.

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Some areas to explore with the client include:

• What does the client hope to achieve through counseling?

• What brings the client to counseling at this time?

• Has the client had therapy in the past? If so, what was it like? What did the client like about past therapy? What did the client dislike about it?

• How will the client know they have made progress in treatment?

• What does the client want to be different in their life?

Managing expectations for the client in therapy

Some clients may come to therapy with false expectations. They may have never gone through counseling in the past or may have not achieved the results they desired in past counseling experiences. 

Some clients may have created expectations regarding therapy from what they have seen on television or in the movies. Some clients may have heard stories from their friends or families about their experiences in therapy. 

You can help to improve your client’s satisfaction and treatment outcomes by clearly discussing and defining what the client can expect to occur in the therapeutic relationship. You can refer to the client’s expressed needs and expectations and then clearly define what to expect in the therapy process.

By clearly describing what therapy with you looks like and clearly defining your practice’s important policies, you can help to manage your client’s expectations and improve their satisfaction with your services.

While your website, paperwork, and policies posted around your office may clearly explain this information, discussing it in session will help to ensure that your client understands and allow the client to ask questions.

You may want to consider discussing some of the following information with your clients:

• What does your assessment process look like?

• How many sessions do you take for the assessment process?

• What does the goal-setting and treatment-planning process look like for you?

• Describe your therapy approach (ex: CBT, EMDR, mindfulness)

• What do the sessions look like after the assessment process?

• Do you assign homework?

• Confidentiality 

• Frequency and length of sessions

• Expectations regarding payment for sessions, co-pays, and other services

• No-show and late cancellation policies

• How to schedule, cancel, or reschedule appointments

• Practice hours

• Guidelines regarding contacting you

• After-hours and emergency coverage

• Other important policies related to your practice

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Measuring client satisfaction

When it comes to assessing and measuring your client’s satisfaction with your practice, you have many options. 

• Utilize a published survey tool created to measure client satisfaction or you can create your own method. 

• Assess client satisfaction at specific intervals in the treatment process. 

• Measure client satisfaction consistent with reviewing treatment plans. 

• Evaluate client satisfaction at regular intervals within their treatment (ex. monthly or quarterly). 

Some practices may have a standing time for measuring client satisfaction for all clients. For example, you may have a policy where you assess for satisfaction every quarter for all your clients vs. individually assigning dates. You can also incorporate the review into your discharge planning process.

Prior to providing your client with whichever measurement tool you use, it is important to discuss it within the session and to explain your purpose for assessing their satisfaction. You can reflect on how you plan to utilize the information to direct and guide their treatment and make any applicable changes to the treatment plan. You can talk to the client about how they feel about answering your questions and try to ensure they do not feel pressured to answer in a certain way to seek your approval.

The Treatment Outcome Profile and the Client Satisfaction Questionnaire are two measures that have been researched and deemed valid and reliable client satisfaction measurement tools.

• The Treatment Outcome Profile is a self-report measurement tool designed for clients receiving mental health services. This tool measures client satisfaction with services. It consists of twenty-seven items that assess the client’s perceived changes in their quality of life, symptoms, and functioning since beginning treatment with you. 

• The Client Satisfaction Questionnaire (CSQ) is another tool used to measure the client’s satisfaction with services. It comes in a variety of versions and languages. The standard version consists of eighteen questions. It also has versions with three, four, and eighteen questions.