My client stares off into the distance. She’s in the middle of an active hallucination. She’s in her mid-twenties, lives with her mom, has been unable to maintain employment, and is chronically suicidal. Her symptoms often become so severe that hospitalization is required. She’s been my weekly client for months.
During my next supervision, I ask my clinical director for advice. “She’s really struggling. What’s best practice when working with someone experiencing schizophrenia?”
My supervisor looks at me kindly and says, “Just do your best.”
It’s not that she doesn’t care—it’s simply the reality of working in a low-income community mental health clinic. These clinics often lack the training, resources, or time to offer the level of support that clients with severe and persistent mental illness need. The truth is, this client would benefit far more from a clinician who specializes in schizophrenia. Someone with deeper training. Someone with more capacity.
After working with many high-risk clients, I began to feel a slow erosion of the passion that once drove me into this field. My hopes of helping people heal started to fade.
But when I work with clients who have experienced narcissistic abuse, obsessive-compulsive disorder, or sexual trauma—clients I feel equipped and inspired to help—I leave sessions energized. I look forward to our meetings. And most importantly, they get better.
This is the difference the right match makes.
The Pressure to Stay Full
Like many therapists, I once dreamed of having a full caseload and a long waitlist—a sign of professional success, financial security, and clinical credibility. But I’ve learned that healing happens not through numbers, but through connection.
A few weeks ago, I messaged the 12 members of my graduate program cohort and asked: “How are you surviving financially right now, especially without help from a partner or family?”
Most had the financial support of a partner’s second income. One friend, who doesn’t, told me she worked five 10-hour shifts each week at one job and built her private practice evenings and weekends. She was able to stay afloat financially—but only by burning herself out.
When I looked at my own life as a single parent, her schedule just wasn’t realistic. I remember us joking that “you just have to work a little burned out for a while.” But there’s truth in that—and a danger.
Many therapists are forced to overwork just to earn health benefits or stay solvent. Seeing over 30 clients per week is not uncommon. This kind of overbooking is often worn like a badge of honor, rather than being recognized for what it often is: a safety concern—for the therapist, and for the clients.
There’s a pervasive myth in our field that the more clients you have
When the Match Is Off
When there’s a misalignment between the therapist’s training or personality and the client’s needs, therapy suffers. Research has consistently shown that the quality of the relationship—not the specific modality—is the strongest predictor of therapeutic success.
I’ve felt it in myself. When I’m not the right match for a client, I dread our sessions. If they cancel or no-show, I don’t rush to save the appointment. I zone out more easily. After too many back-to-back sessions, I lose my ability to truly be with the person in front of me.
Sometimes I keep a client I know I’m not well-suited for because I need the income. But this doesn’t serve them—or me.
Take Psychology Today, the most widely known directory for therapy seekers. As I scroll through profiles, I notice how many clinicians list everything from eating disorders to trauma to couples counseling to ADHD to parenting skills. It’s the digital version of being everything to everyone.
But mental health isn’t one-size-fits-all. We need specialists.
For example, OCD affects roughly 1 in 10 individuals over their lifetime. But it takes an average of 7 years for someone with OCD to get an accurate diagnosis and appropriate treatment. When OCD is treated like general anxiety, the wrong interventions can worsen the symptoms. The same goes for eating disorders. Without targeted expertise, therapy can do more harm than good.
Just like medicine has general practitioners and specialists, so should therapy.
Refining Success in a Caseload
Success as a clinician should not be measured by the number of clients you see, but by the alignment between your strengths and the client’s needs.
When I was finishing grad school, I was matched with a young woman who had survived sexual abuse and was raised in a cult. We met weekly. She was kind, soft-spoken, and guarded. It took months before she opened up. Nearly a year passed before she felt safe enough to share her full story.
I was a new clinician with limited experience. I didn’t use fancy interventions. But she told me I was the only therapist she’d ever felt comfortable being completely honest with.
The quality of her care didn’t come from complex techniques. It came from connection, consistency, and the space to move at her own pace.
When therapists are overbooked or misaligned with their clients’ needs, this kind of healing gets lost in the shuffle.
A Better Way: How NextTherapist Is Changing the Model
Finding a therapist shouldn’t feel like a maze—and keeping your caseload full shouldn’t mean compromising care.
At NextTherapist, we’re working to fix this.
Our platform helps clients find therapists based on real alignment—not just availability or a list of vague specialties. We encourage therapists to narrow their focus and identify their true areas of expertise, rather than listing every possible condition they’ve encountered. This helps clients find someone who’s not just available—but actually qualified.
Unlike directories that function more like outdated phone books, our technology lets clients book with you directly—no missed calls, no back-and-forth emails, no lost revenue. Fewer clients fall through the cracks. More of the right clients find their match.
And unlike some matching platforms, NextTherapist ensures geographic accuracy. You won’t be matched with a therapist in a different state or time zone. We know how important accessibility, availability, and connection really are.
In summary, therapy is not about filling a calendar. It’s about creating the right space for healing to happen. The right match between therapist and client is not just a nice-to-have—it’s the foundation of good mental health care.
Let’s build a model that honors that.
