Caseload Trends Survey 2026

1
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
2
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
3
What is your highest level of education?* This field is required.
Bachelor's Degree
Master’s Degree
Doctorate (PsyD, PhD)
Other
4
What are your clinical credentials?* This field is required.
PsyD
PhD
MD
DSW
LCSW
LMFT
MSW
CMHC
LMHC
PMHNP
Other
5
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
6
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
7
If you provide telehealth sessions, do you also have an interstate approval?* This field is required.(e.g., PsyPact, Social Work Compact, etc.)
YESNO
8
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
9
Has the demand for telehealth increased, decreased, or remained steady over the past year?* This field is required.
Increased
Decreased
Stayed the same
10
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)
11
If you practice in-person, what geographic region do you practice in?* This field is required.
Urban
Suburban
Rural
Not Applicable
Other
12
Do you currently accept insurance?* This field is required.
YESNO
13
Do you routinely accept payment from third party payors other than insurance (e.g., EAP contracts, clergy pay, etc.,)?* This field is required.
YESNO
14
If you work with self-pay clients, do you offer sliding-scale fees?* This field is required.
Yes
No
Does not apply
15
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
16
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.
17
Are you accepting new clients?* This field is required.(Even if you have a waitlist)
YESNO
18
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)
19
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.
20
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.
21
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
22
How have your rates changed over the past year?* This field is required.
Increased
Decreased
Stayed the same
Other
23
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
24
Have you considered leaving private practice due to financial challenges?* This field is required.
Yes, strongly considering
Yes, but not urgently
No
Does not apply
25
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
26
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
27
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.
28
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.
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Large
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Ok
29
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
30
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
31
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
32
Would you be interested in attending a Webinar to review results of survey?
YESNO
33
Would you be open to a follow-up conversation or interview about your experience in the industry?
YESNO
34
Is there anything else you feel would be helpful to note about your caseload experience as a mental health provider? (Optional)
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Small
Ok
Ok
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