Caseload Trends Survey 2026

Which of the following best describes your CURRENT practice setting?If you have multiple, please select the option where you have the highest caseload.

Solo Private Practice (self-employed)

Group Private Practice (as an employee or contractor)

Community Mental Health Center (CMHC)

Hospital or Medical Center (in-patient)

Hospital or Medical Center (out-patient)

Academic or University Counseling Center

School-based Setting (K-12)

Other

How many years have you been practicing as a licensed mental health provider?* This field is required.

I am a pre-licensed provider.

0-2 years

3-5 years

6-10 years

11-15 years

16+ years

Other

What is your highest level of education?* This field is required.

Bachelor's Degree

Master’s Degree

Doctorate (PsyD, PhD)

Other

What are your clinical credentials?* This field is required.

PsyD

PhD

DSW

LCSW

LMFT

MSW

CMHC

LMHC

PMHNP

Other

In which state(s) are you licensed to practice in-person?* This field is required.Select all the apply

Not in USA

Alabama

Alaska

American Samoa

Arizona

Arkansas

California

Colorado

Connecticut

Delaware

District of Columbia

Florida

Georgia

Guam

Hawaii

Idaho

Illinois

Indiana

Iowa

Kansas

Kentucky

Louisiana

Maine

Maryland

Massachusetts

Michigan

Minnesota

Mississippi

Missouri

Montana

Nebraska

Nevada

New Hampshire

New Jersey

New Mexico

New York

North Carolina

North Dakota

Northern Mariana Islands

Ohio

Oklahoma

Oregon

Pennsylvania

Puerto Rico

Rhode Island

South Carolina

South Dakota

Tennessee

Texas

Utah

Vermont

Virginia

Washington

West Virginia

Wisconsin

Wyoming

U.S. Virgin Islands

Other

In which state is your primary residence?* This field is required.

Alabama

Alaska

American Samoa

Arizona

Arkansas

California

Colorado

Connecticut

Delaware

District of Columbia

Florida

Georgia

Guam

Hawaii

Idaho

Illinois

Indiana

Iowa

Kansas

Kentucky

Louisiana

Maine

Maryland

Massachusetts

Michigan

Minnesota

Mississippi

Missouri

Montana

Nebraska

Nevada

New Hampshire

New Jersey

New Mexico

New York

North Carolina

North Dakota

Northern Mariana Islands

Ohio

Oklahoma

Oregon

Pennsylvania

Puerto Rico

Rhode Island

South Carolina

South Dakota

Tennessee

Texas

Utah

Vermont

Virginia

Washington

West Virginia

Wisconsin

Wyoming

U.S. Virgin Islands

Other

If you provide telehealth sessions, do you also have an interstate approval?* This field is required.(e.g., PsyPact, Social Work Compact, etc.)

YESNO

Approximately what percentage of your sessions are conducted via telehealth vs. in-person?* This field is required.

0% Telehealth; 100% In-Person

10% Telehealth; 90% In-Person

20% Telehealth; 80% In-Person

30% Telehealth; 70% In-Person

40% Telehealth; 60% In-Person

50% Telehealth; 50% In-Person

60% Telehealth; 40% In-Person

70% Telehealth; 30% In-Person

80% Telehealth; 20% In-Person

90% Telehealth; 10% In-Person

100% Telehealth; 0% In-Person

Has the demand for telehealth increased, decreased, or remained steady over the past year?* This field is required.

Increased

Decreased

Stayed the same

In your experience this past year, what has been the biggest factor influencing whether clients choose telehealth or in-person services? (Select one.)* This field is required.

Convenience and scheduling (e.g., reducing travel time, fitting appointments around work, school, childcare, caregiving responsibilities, or other commitments)

Distance or transportation (e.g., clients live far from the office, lack reliable transportation, or have mobility challenges)

Personal preference or therapeutic fit (e.g., clients simply prefer one format or feel more comfortable, engaged, or connected)

Clinical appropriateness or provider recommendation (e.g., one format is recommended based on the client's symptoms, treatment goals, or safety needs)

Privacy or confidentiality (e.g., clients have greater privacy at home or prefer the privacy of the office)

Insurance coverage or cost (e.g., insurance benefits, copays, reimbursement policies, or other financial considerations)

Health or medical considerations (e.g., physical health conditions, illness, disability, immune compromise, or anxiety about exposure to illness)

Seasonal factors (e.g., summer break, school schedules, holidays, weather, or other time-of-year considerations)

If you practice in-person, what geographic region do you practice in?* This field is required.

Urban

Suburban

Rural

Not Applicable

Other

Do you currently accept insurance?* This field is required.

YESNO

Do you routinely accept payment from third party payors other than insurance (e.g., EAP contracts, clergy pay, etc.,)?* This field is required.

YESNO

If you work with self-pay clients, do you offer sliding-scale fees?* This field is required.

Yes

Does not apply

Approximately what percentage of your caseload is self-pay?* This field is required.

0-10%

11-25%

26-50%

51-75%

76-100%

Does not apply

Other

Is your caseload currently full?* This field is required.

Yes, and I'm not accepting new clients.

Yes, but I am accepting new clients for a waitlist.

No, I am accepting new clients.

Are you accepting new clients?* This field is required.(Even if you have a waitlist)

YESNO

Over the past year, how often has your caseload been full?* This field is required.

Rarely (0-25% of the time)

Sometimes (26-50% of the time)

Often (51-75% of the time)

Almost always (76-100% of the time)

In your experience, when is your caseload typically at its LOWEST?* This field is required.

Winter (December–February)

Spring (March–May)

Summer (June–August)

Fall (September–November)

My caseload does not have a consistent seasonal low point.

I'm unsure.

In your experience, when is your caseload typically at its HIGHEST?* This field is required.

Winter (December–February)

Spring (March–May)

Summer (June–August)

Fall (September–November)

My caseload does not have a consistent seasonal high point.

I'm unsure.

In your experience this past year, what has been the biggest factor contributing to fluctuations in your caseload?* This field is required.

Seasonal patterns (e.g., summer break, holidays, weather, or other predictable times of year)

Referral volume (e.g., changes in referrals from providers, organizations, or word of mouth)

Economic or financial factors (e.g., clients' finances, employment, insurance costs, or affordability)

Provider availability (e.g., schedule changes, time off, or appointment availability)

Client attendance and retention (e.g., cancellations, no-shows, dropouts, or treatment completion)

Changes in demand for mental health services (e.g., more or fewer people seeking care)

There's been no fluctuations in my caseload this past year.

Other

How have your rates changed over the past year?* This field is required.

Increased

Decreased

Stayed the same

Other

If you raised your rates in the past year, what was the primary factor influencing that decision? (Select one.)* This field is required.

Increased operating expenses (e.g., rent, payroll, insurance, software, or other business costs)

Inflation or cost of living (e.g., rising prices or general economic conditions)

High demand or a full caseload (e.g., demand consistently exceeded availability)

Experience, training, or specialization (e.g., increased expertise, certifications, or expanded services)

To align with market rates (e.g., bringing fees in line with other providers in my area or specialty)

Changes in insurance reimbursement or payer policies (e.g., reimbursement rates or contract changes)

Practice growth or business strategy (e.g., repositioning the practice, reducing caseload, or increasing sustainability)

Personal financial needs (e.g., income goals or changes in personal financial circumstances)

I didn't raise my rates.

Other

Have you considered leaving private practice due to financial challenges?* This field is required.

Yes, strongly considering

Yes, but not urgently

Does not apply

In your experience this past year, what has been the single biggest challenge facing your practice?* This field is required.

Generating enough new client inquiries or referrals (e.g., attracting enough new clients to meet demand)

Maintaining a stable caseload (e.g., cancellations, no-shows, early termination, or fluctuating demand)

Insurance and reimbursement (e.g., credentialing, reimbursement rates, claim denials, or payer requirements)

Financial sustainability (e.g., rising operating costs, inflation, or maintaining profitability)

Administrative workload (e.g., documentation, scheduling, billing, or other non-clinical responsibilities)

Workforce and staffing (e.g., hiring, retaining, supervising, or supporting clinicians and staff)

Provider burnout and work-life balance (e.g., managing workload while maintaining personal well-being)

Keeping up with technology (e.g., AI, telehealth, EHRs, cybersecurity, or adopting new tools)

Changing client expectations and behaviors (e.g., expectations around communication, scheduling, telehealth, cost, or clients turning to AI or self-help resources)

Other

Which of the following would have the greatest positive impact on your practice right now?* This field is required.

Better insurance reimbursement rates (e.g., higher reimbursement, fewer claim denials, or improved payer policies)

Business and marketing support (e.g., attracting clients, practice growth, or business strategy)

Access to affordable continuing education and certifications (e.g., CE courses, advanced training, or specialty certifications)

Administrative support (e.g., billing, credentialing, scheduling, documentation, or other practice operations)

Clinical consultation and peer support (e.g., supervision, case consultation, or networking with other providers)

Technology and AI support (e.g., practice management software, AI tools, telehealth, or workflow automation)

Legal and ethical guidance (e.g., compliance, documentation, risk management, or ethical decision-making)

Mental health provider well-being (e.g., burnout prevention, resilience, or work-life balance)

Community referral networks and partnerships (e.g., stronger referral relationships with providers or organizations)

Resources for practice growth and expansion (e.g., hiring clinicians, opening additional locations, or growing a group practice)

Advocacy for mental health policy changes (e.g., legislation, reimbursement reform, or reducing administrative burden)

Grants or financial assistance (e.g., funding opportunities or financial support for practices)

More flexibility and control over session rates and practice policies

Overall, how important are online therapist directories in generating new client inquiries for your practice?

They are my primary source of new client inquiries.

They are a major source of new client inquiries.

They are a minor source of new client inquiries.

They rarely generate new client inquiries.

I do not use online therapist directories.

If you've noticed any changes in referral flow from any of the directories you're listed on, please describe.* This field is required.Be sure to mention the specific directory and how its referral flow has changed for you.

Which marketing tactic has generated the MOST new client inquiries for your practice in the past year?

Online search (e.g., your website, SEO, blogging, Google Business Profile, or other unpaid Google search visibility)

Online directories (e.g., Psychology Today, Zencare, TherapyDen, or Mental Health Match)

Professional networking and referrals (e.g., relationships with other providers, physicians, schools, or community organizations)

Speaking and educational outreach (e.g., trainings, workshops, webinars, conference presentations, or podcasts)

Social media (paid or organic)

Email marketing

Community outreach (e.g., health fairs, vendor booths, community events, or local sponsorships)

Paid advertising (e.g., Google Ads or Meta/Facebook/Instagram ads)

AI recommendations (e.g., clients finding your practice through ChatGPT, Gemini, Claude, or other AI assistants)

I do little or no active marketing.

Other

Would you like to receive a summary of the survey results?* This field is required.If YES, your email is required (below) but will not be used for any other purpose besides the dissemination of these survey results.

YESNO

What is your email so that we can send you the results?* This field is required.Your email will not be used for any other purpose besides the dissemination of these survey results. Please double-check for typos!

example@example.com

Would you be interested in attending a Webinar to review results of survey?

YESNO

Would you be open to a follow-up conversation or interview about your experience in the industry?

YESNO

Is there anything else you feel would be helpful to note about your caseload experience as a mental health provider? (Optional)