5 Questions to Answer When Deciding the Size of Your Caseload
6 minute read.
How many clients does a therapist have?
Therapists entering into private practice have a difficult decision to make: “How many people should I see in a week?”
Like most hard questions, the answer will be different for everyone. And as time goes on, our individual answers may change.
I have come to love coaching therapists who have been exploited by managers, bosses and supervisors. These therapists share a similar journey with me, and there is nothing like helping a helper realize their own value and power.
It is with this passion that I write about a question that can feel impossible to answer, especially for therapists who are healing from exploitation.
A Day in the Life of a Therapist
As therapists who do not work the typical 9-5, 40 hour work week, we can often feel that we need to account for our days hour by hour (thanks a lot, capitalism). Realistically, this structure of labor simply does not fit when it comes to the therapy field.
There are some therapists who report that they are able to work 40+ clinical hours per week—I did so myself for a time. But it was unsustainable. My health suffered, my work suffered, and the only escape was leaving a bad job.
Therapists going into private practice must decide for themselves how much recovery time is needed in order to remain in the field long term. If you are seeing 8 clients a day, 5 days a week, you will likely not have enough emotional, physical or cognitive energy left for your personal life.
Everyone who has ever worked a job is likely able to recall a time in when they struggled to “turn off“ at the end of the day, or stop thinking about their job. With therapists, this is a uniquely challenging.
You are not concerned solely with your wellbeing, your income security, your health and relationships at work. You are also focused on the clients you have seen all day, some for months or years at a time.
I am in no way suggesting that the typical American worker does not face daily challenges. Working in our exploitative system is not good for us. I am, however, suggesting that working a 40 hour work as a mental health therapist is not sustainable.
So, what do therapists do all day?
I’ve written about my morning routine before. I discovered the benefits of routine and consistency in the years since grad school. As time went on, I noticed a startling connection between unresolved trauma and my militant adherence to routine. If my routine was interrupted, I could be thrown off for the entire day.
In my own therapy work, I have become lovingly diligent in identifying pockets of unresolved trauma and reparenting myself. This has allowed for me to find solace in routine, rather than escape.
These days, I have my mornings, my work prep time, my sessions, and a leisurely evenings. On non-clinical weekdays, I spend my time blogging, doing social media outreach and working on other side projects (including my podcast!)
On the weekends, I rest and I socialize. I love doing puzzles and building Legos, getting creative, hiking, and spending time with my wonderful partner and our kitties.
With all this in mind, I put together this list of questions to ask yourself when deciding the size of your therapy caseload. Happy reading!
5 Questions to Answer When Deciding the Size of Your Therapy Caseload
1. How many clients can you see a day?
As stated above, the answer to this question will be different for every therapist. Personally, 4 clients per day feels comfy for me. I will see 5 clients per day maybe once or twice a week. I know that I will be tired at the end of the day, but I also know that all 5 of those clients will receive good quality care.
If I was still seeing 6-10 clients per day, like I did at my old job, I could not honestly say that all of my clients would receive safe, high quality treatment.
Letting go of internalized ideas about what you “should“ be able to do throughout your day is important. Not only is this type of thinking rooted in ableism, but it is a result of working in an exploitative system.
I will also compassionately remind you that this mindset is not your fault. It is impossible to be a worker in the US and not feel the effects of capitalism.
However, for your own liberation to occur, it is your responsibility to unlearn this mindset to the best of your ability. This may take years of healing, but it is possible.
2. What is your desired salary?
This can be an extremely difficult question to answer as a therapist. The field is made up of mostly women, nonbinary AFAB people and increasing numbers of BI&POC individuals–all groups that have been taught since birth that their labor has less value.
It may feel strange, but as a private practice owner, you get to pick your salary. That means adding up your daily, monthly and yearly expenses and deciding how much you’ll need to earn to feel comfortable.
You’ll need to factor in your student loan payments, cost changes due to inflation/profiteering, saving for retirement, etc. The hardest part of this will likely be budgeting for pleasurable activities.
Give yourself time to become comfortable with the idea of taking home the salary you deserve. Also, be ready to forgive yourself for crossing your own boundaries. This stuff is hard! You will be unlearning a lot of unhealthy ideas about work instilled by our capitalist system.
To help you along your way in deciding your target salary, you can use the tool below. Feel free to input different numbers until you find something comfy.
Decide how much money you want to make. Ex. $100,000
Divide that by how many weeks you want to work per year. Ex. 48 weeks
Divide that by how many clients you want to see per week. Ex. 15
Your rate! Ex. $138.89
So, if you want to make $100,000/year and work 48 week per year, you will aim to make $2,083.33 per week. If you want to see 15 clients per week, you will need to charge $138.89 per session. (I encourage rounding this up to $140 for easy adding come pay day!)
3. How many days per week do you want to see clients?
Most workers in the US have experienced the traditional Monday through Friday, 9-5 work week. Some therapists will automatically believe that this rule of thumb applies to them, despite the emotional labor it takes to be a good therapist.
Do you want one non-clinical weekday reserved for doctors appointments, childcare, housekeeping, non-clinical work (blogging, marketing), or leisure? Want to experience the immense joy that is 11am on a Monday in the grocery store?
Personally, I enjoy having clinical hours on Tuesdays, Wednesdays and Thursdays. I am able to see my target caseload of 13 clients in three days, leaving Mondays and Fridays for life maintenance, rest and other adventures. (This summer, I worked part-time on an organic farm!)
4. Who is your ideal client?
Have you decided your niche? This is a good first step.
Be warned, if you are advertising for “adults with anxiety and depression” you are not only casting a vaguely wide net, but you’re competing with almost every therapist in your region or city.
Your niche should be specific, with layers that include symptoms, personality, identity and needs. With my coaching clients, we can sometimes dedicate hours to establishing a niche.
For example, my niche is professional millennials/Gen Zs from working class backgrounds. I know that this particular niche experiences stressors that accompany changing socioeconomic classes (while possibly owning less than their working class parent(s)/care givers due to debt and wage stagnation), shame, anxiety, poor boundaries and issues with money.
Once you identify your niche, you can begin to advertise for these specific clients.
This is also a good opportunity to identify what you can and cannot tolerate in session. I am comfortable working with all types of trauma, but I find it difficult to work with clients who are experiencing suicidal thoughts. Other therapists may feel the exact opposite.
Do yourself a favor by setting boundaries around what types of symptoms you will be able to tolerate from clients. This is not only ethically necessary, but it can help you feel more comfortable with not being an expert in everything. (Another opportunity for healing!)
If you decide that your ideal client has high needs, you may consider working less hours, or setting aside a fixed number of hours to commit to these particular cases.
Clients with more high needs have a right to care, including having a therapist who is not burnt out.
5. How will you get paid as a therapist?
Will you take insurance? Medicaid, Medicare? Will you be strictly cashpay and offer superbills with one or two sliding scale spaces?
Whatever you choose, it should be sustainable. If you have decided to see less than 15 clients per week, you may not want to get paneled with an insurance provider that offers you a low reimbursement rate.
On the other hand, if you wish to work with low income individuals, you may not choose to be cashpay only as you would forgo government assistance reimbursement opportunities.
If you have read my blog before, you know that I am firmly anti-capitalist and anti-exploitation and I believe that every individual should have access to any service that can make their lives better. I also know that it’s impossible to reach everyone in need as one clinician.
That being said, you can be anti-capitalist in a capitalist system. You can do this by charging a rate that is economical and fair given the cost of your education, experience and skills. You can also do this by not working at/owning mill group practices that take a percentage of therapists’ wages.
I decided that I will make enough money to pay my rent and student loans, save for retirement, keep a home that I can live in comfortably, and have experiences that are important to me.
I do not exploit the labor of any fellow workers, I charge my clients what they can pay without going broke, and I care for myself.
So, how many clients does a therapist have?
By now, you can allow yourself to begin asking how many clients you want. Another therapist’s ideal private practice may look very different from your own.
Remember, there cannot be blanket answers when it comes to labor because every job is different. We also all have different bodies with different abilities. We have different financial needs, stressors, identities and different ideas about how a therapist should look.
Our capitalist culture will tell you to work, work, work until you can do nothing else. As a result you will feel devastating productivity guilt, burnout, and a whole lot of shame.
For these reasons, I lovingly challenge you to look at what your needs are, what your family’s needs are, and what your community’s needs are. The answers to these questions can help you decide how big your caseload will be, and what kind of therapist you want and need to be.
Thank you for reading!
Email contact@teletherapywithsarah.com with questions/comments/love.
Online anxiety therapy, depression therapy, trauma therapy for professional millennials/Gen Zs + workers in Pennsylvania.
Online international therapist business coaching for clinicians who have been exploited by managers, bosses and supervisors. Helping therapists build their dream private practices.
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Very Best,
—Sarah (she/her)
*Disclaimer - This piece was written by a cis/het, able bodied, white woman. Intersectionality (coined by lawyer, civil rights advocate, scholar and philosopher Kimberlé Crenshaw) tells us that race, ethnicity, class, sexuality, gender, etc. that differ from the above identifiers encounter hardship and oppression at a much higher rate.*
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