As therapists, we know the therapeutic relationship is the most powerful predictor of success in therapy. But when exactly does that relationship begin? The truth is, it starts the moment a client walks into your office—or logs onto your video call—for the very first time.

If you're seeing clients drop out of therapy after just one to three sessions ("client churn"), the solution often lies in how we show up during those first critical sessions. Let’s break down some concrete, actionable ways to build trust, connection, and engagement from the start.

1. Reframe the Intake: From Interview to Coffee Date

Many of us were trained to treat the first session like an interview: a fast-paced series of questions covering family history, medications, presenting symptoms, and more. While gathering information is important, the intake shouldn’t feel like a one way interrogation. It should feel relational—like getting to know someone over coffee.

If a coffee date doesn’t resonate, think of your first few sessions as a reciprocal interview. You’re assessing your client, but they’re also evaluating you. In a world where clients have more choice than ever, they won’t stick around if they don’t quickly feel seen, heard, and hopeful. Clients need to feel like they are entering a relationship – not responding to a questionnaire.

Make it relational, not robotic:

• Ask open-ended questions:
  “If therapy goes really well, what would be different in your life?”
• Share small, relevant personal details:
  “I love that coffee shop too—their banana bread is my favorite”
• Offer reassurance that you understand:
  “I specialize in supporting people through tough transitions just like you’re experiencing.”
• Reflect both content and emotion:
  “It sounds like you’ve been feeling stuck for a long time, and that’s taken a toll.”
• Drop the script:
  Unless your practice requires it, resist reading questions from an assessment. Let the conversation flow naturally and trust that you’ll gather the necessary information throughout the session.

2. Establish Rapport Early—Concrete Strategies

Rapport isn't abstract; it’s built through intentional, repeatable behaviors. Practice these every session:

• Bring up details they shared in a previous session: “How is Sammy doing after his operation?” Remembering details like their dog’s name can illustrate you’re fully present and paying attention. 
• Validate and normalize: “It makes total sense you’re feeling overwhelmed given all you’ve been juggling.”
• Use humor (appropriately): A little levity goes a long way in easing tension.
• Ask how they’re feeling about therapy: “How’s this experience feeling so far?”
• Name their strengths: “You’re incredibly insightful about your feelings—that’s going to be a huge asset here.”

Strong rapport lays the groundwork for trust, which keeps clients coming back.

3. Clarify Expectations and Explain the Process

Unclear expectations are a major reason clients drop out of therapy prematurely. Many don’t know how therapy works and the need for consistency in order to achieve their goals. Spell it out early:

• Explain the structure:
  “We’ll start with at least eight weekly sessions, and after the eighth session, we can adjust based on how things are progressing.” When clients know what to expect, they’re more likely to stick with it.
• Emphasize the importance of consistency:
  Therapy works best when there's momentum. Weekly sessions create a consistent rhythm where trust builds and real change starts to unfold. When sessions are spaced out more than a week apart—like every other week —it’s harder to stay connected to the work.
• Invite feedback regularly:
  “Let me know if anything we’re doing isn’t working for you—open communication is really important for this to work. 
  

4. Uncover What They Really Want from Therapy

Understanding the presenting problem is just the beginning. To truly engage clients, you need to understand what change would be meaningful to them.

• “If our work together is successful, in six months from now, how would your life be different? What would I see you doing?” 
• “What made now feel like the right time to reach out?”

Then reflect what you hear:

• “So while anxiety brought you here, what you really want is to participate more fully in your life by showing up to social events and cultivating richer relationships.”

5. Build Client Confidence: Show That You Can Help

A big driver of early churn is doubt. Clients may leave if they aren’t confident that therapy (or you) will actually help.

Here’s how to instill confidence:

• Name the problem clearly:
  “Anxiety has made it tough to show up the way you want at work and in your relationships.”
• Offer reassurance:
  “I’ve worked with many clients who experience heightened anxiety when the stakes are high at work. You’re not alone, and I can absolutely help with this.”
• Lay out your approach and plan:
  “As an ACT therapist, I’ll help you make space for anxiety instead of fighting it, so it doesn’t have to control your life. Together, we’ll focus on what matters most to you and build the tools to move forward—even when anxiety shows up. How does that sound to you?”

To reduce client churn and foster lasting therapeutic relationships, focus on these essentials in your first three sessions (and, of course, beyond):

• Make your intake conversational and collaborative
• Build rapport with intentional, relational behaviors
• Set clear expectations and explain the process
• Understand what your client really wants to get out of therapy and what that looks like
• Instill confidence that you understand, you have a plan, and you can help

These aren’t just nice-to-haves—they’re vital tools to help clients feel seen, hopeful, and motivated to return. When clients experience early sessions as meaningful and personalized, therapy becomes a commitment they’ll stick with.

PracticeVital Makes Tracking Metrics as Easy as Possible

Manually keeping track of metrics is time consuming and can feel overwhelming which can lead practice owners to give up on them. PracticeVital is designed to provide therapy practice owners and their teams with real-time insights into their business and clinical performance. From monitoring clinician utilization rates to tracking revenue trends, PracticeVital gives you everything you need to make data-driven decisions with confidence– and it does so without any manual data entry on your part.

By focusing on key metrics, you can build a thriving, efficient therapy practice that delivers exceptional care– while growing sustainably. Let PracticeVital make your job easier and be your partner in helping you grow a thriving practice.