Want to offer free sessions? First know the risks

Decades of research suggest that a good patient-therapist relationship is essential to helping patients connect with, remain in and get the most from therapy (Psychotherapy, Vol. 55, No. 4, 2018). So, it can make sense to offer patients a free 20- to 30-minute phone consultation before an initial intake session to make sure you mesh well together and that you are well versed in any treatment they are looking for.

“Going through an initial intake takes so much emotional energy on the client’s part, and requires people to arrange their schedule to come in or participate virtually, and spend the co-pay,” says Connecticut private practitioner Carrissa Phillippe Phipps, PhD, who works mostly with college students dealing with anxiety and depression, as well as adults experiencing major life transitions such as a divorce or major career change.

She offers all potential clients a 30-minute free phone consultation. “Then, it could turn out to all be for nothing if we aren’t a good fit for each other or I don’t provide the treatment he or she is looking for.”

Further, for some clients, the decision to get psychological help is not made lightly, notes Pennsylvania private practitioner Pauline Wallin, PhD.

“By the time a person makes their initial appointment, they have probably been thinking about it for months or years,” she says. A free brief consultation can help reduce the uncertainty of what to expect, such that the prospective client is more apt to enter treatment sooner rather than later.

But not all practitioners are on board with the idea. Some say the practice devalues psychologists’ services and caution that patients may just want quick advice or may not be as committed to the work of therapy if they talk to you for free the first time.

“It diminishes the value of your therapy,” says Florida private practitioner Michael Spellman, PhD. “The message that the first one is free is great, if you’re an ice cream parlor, but it doesn’t communicate to people all the years of training you have as a practitioner.”

Some psychologists also question how useful a free consultation really is since they do not enable a psychologist to delve into the details behind why a client is looking for a therapist. Still others worry that a free consultation may establish a client-psychologist relationship.

“Once that relationship is established there are state and federal regulations that need to be met, including the need to ensure appropriate transfer of care, if the psychologist determines they are not able to meet the needs of the client,” says Anne Huben-Kearney, RN, assistant vice president of risk management for AWAC Services Company, a member company of Allied World (the risk management provider of the American Professional Agency Inc., APA’s professional insurance carrier).

To help you decide what will work best for your practice, consider this advice:

Huben-Kearney notes that it’s important for psychologists to understand the potential ethical and legal pitfalls of offering a free consultation, including the inability before the consultation to ensure a potential client’s needs are within the psychologist’s scope of practice and competency, as well as avoiding the establishment of a client-therapist relationship.

It can be difficult to determine exactly when the therapy relationship begins, Wallin notes.

“When you as a clinician think the client-therapist relationship begins may not be the same as when the person at the other end of the phone line defines the start of the relationship,” Wallin says.

She points to a hypothetical example of a mom who might be seeking help for her rebellious teenage daughter, and you offer her an appointment for early next week. Before hanging up, she asks for your advice on whether she should allow her daughter to attend a gymnastics competition, even though she is grounded. You quickly talk through this decision with her—perhaps as a way to impress her with your expertise—and end up advising her to keep her daughter home. The following Monday, the mom calls to cancel her appointment because her daughter is in the hospital after cutting herself, and threatens to sue you for malpractice and to report you to your licensing board.

“While she may or may not prevail in a lawsuit or licensing board complaint, it is apparent that she did assume that she was already in a professional relationship with you,” Wallin says. “Even though she had not yet met you in person, you were behaving like a treating psychologist, simply by asking probing diagnostic questions and giving specific advice.” The bottom line, experts say, is to make sure to set expectations up front as to what the phone call will entail, says Washington, D.C., private practitioner Kirsten McNelis, PhD.

“There’s definitely an educational component at the beginning of the conversation, so that people don’t consider the call to be like a mini therapy session,” she says.

Wallin recommends not even calling the discussion a “session” since that implies a clinical bent. Holding a short screening call—keeping it no longer than 10 minutes as opposed to 20 or 30—is a good practice to do routinely, says Jeff Zimmerman, PhD, an independent practitioner in New York and Connecticut and cofounder of the Practice Institute. “Twenty minutes is a long time, and puts you at greater risk that the potential client could start asking for immediate advice or suggestions,” he says. Keep the call to five or 10 minutes so you can hear the patient’s concerns, gauge whether the client is a good fit for your services, and talk about scheduling and costs.

Establish the parameters of the call up front so that the prospective client understands the boundaries. For example, disclaim that you are not initiating a relationship but are there to answer questions about your qualifications and approach to treatment, and assess whether your personalities match. Caution them about sharing details and asking you for advice. Remind them that you cannot provide diagnostic or therapeutic services during the call, and that you are not going to act as their psychologist unless they come in to initiate the relationship.

McNelis and Phipps both say that these initial calls allow them to share a bit about how treatment works and what’s expected, as well as logistical information related to schedules and insurance and cost issues. “I always want potential clients to know what they’re looking at in terms of their financial responsibility, and explain fees if I’m not in their network,” McNelis says.

An initial phone conversation also allows clinicians to refer out if necessary. For example, if during a call you realize you don’t have the expertise a patient needs, you can refer him or her to a more suitable provider. “People often say how appreciative they are of my honesty and the recommendations I give in those situations,” Zimmerman says.

Instead of a free consultation, you might want to promote your services and expertise by providing free lectures in the community or writing articles for the local paper. Wallin also suggests that practitioners consider developing a welcome video to post on their website in lieu of promoting free 20-minute consultation calls.

“This would allow viewers to get a glimpse into your personality, treatment practices and specialties,” she says. “There are ways to make videos very inviting and to give people a sense of what it’s like to talk with you, while also being clear that it’s not yet a therapeutic relationship.”