Maybe you tried telehealth for your counseling practice during the COVID-19 shutdown, and you’ve decided you would like to stick with it. Or maybe you’ve always wanted to go all-in on telehealth but weren’t sure you could get enough clients to sustain your business.

The good news is that many counselors are successfully carrying a full caseload of telehealth clients.

How do they do it? And how long does it take to get a full caseload if you only see clients via telehealth?

“That depends,” said Cindy Norton, an LMFT in Asheville, North Carolina.

Norton owns AVL Couples Therapy - a practice that specializes in helping happy couples. She also owns Mountain Practice Journeys where she provides business coaching and custom web-design services for therapists. She recently launched a podcast where she shares helpful information for starting and growing a private counseling practice.

In a recent interview with Raymond Barrett, CEO of the Telehealth Certification Institute, Norton said many variables impact how quickly you can ramp up your practice including your counseling niche, and whether you take insurance. The quality of your online profiles and your website also may impact whether you can easily attract new clients. Your skills as a clinician and your ability to network with other therapists both matter as well.

Statistics indicate you will likely lose money in your first year in business, Norton said. “In your second year in business, a lot of times you break even,” Norton said. “In your third year in business, you’re likely to make a profit.”

Some counselors have a full caseload on “Day One” in their telehealth practice because they left a group practice and took their clients with them. By contrast, growing a fully private pay telehealth practice from scratch could take three years.

“With insurance-based practices, on average, I hear it takes about six months to a year and a half,” Norton said. Again, private-pay practices usually take longer to ramp up - up to three years.

Norton said therapists need to be willing to loosen the purse strings. 

“It can be really scary to start spending money before you’re making money,” Norton said. “It really is important to get some of those basics.”

She said telehealth does make it easier.

“When I opened up my practice, I was fully in person. I had never considered telehealth, so I had the expenses of an office and furnishing an office - which is expensive.”

Norton said counselors shouldn’t go deep in debt, but there are essentials to get set up early in your practice, including your practice management software. 

“With telehealth, make sure you have good technology so that it’s a seamless experience for your clients,” Norton said. 

She also reminds therapists to think digital when they develop their marketing plans. She said it’s important to have a high-quality digital headshot and a video demonstrating how you conduct a session.

“Having a good quality headshot and a really nice short video can be amazing to have on your website,” Norton said. “When someone lands on [your website] they get to see a quality image of you, they know they can connect with you.” 

Norton also encouraged therapists to network locally with other therapists in their community to build up referrals. 

Having a great website that’s easy to navigate and has well-written copy also is essential. If you aren’t a great writer, Norton said to consider hiring a writer. You also can try recording yourself on your phone and then converting your conversation into website content. 

“Not having it scripted in any way - you’re just talking and answering questions to yourself about your ideal clients and who you love working with… you just speak to that.”

Norton said you can pull some great nuggets from your recording to use on your website.

Remember, the goal for your website is to connect with your client in plain language, to offer hope for transformation, and then to give them a path forward with therapy. 

By Amanda Barnett, LPC, NCC, Ed.S.