Why December Is a Slow Month for Therapists — and How to Stay Steady

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written by Michelle Conrad, LCPC, for Personal Balance Counselng and our community of clinicans

December brings joy, connection, and celebration—but for therapists, it often brings something else: a sudden slowdown. Fewer intakes, more cancellations, and inconsistent billing can make the month feel unstable and unpredictable.

The good news? December’s dip is normal, expected, and completely manageable with the right strategy. When therapists understand why this pattern happens—and prepare accordingly—they can keep their caseloads strong, help clients maintain momentum, and enter January (the busiest month of the year) feeling organized, refreshed, and financially stable.

Why December Slows Down in Mental Health Practices

1. Routines collapse during the holidays

Kids are off school. Work hours shift. Clients travel or host family. Therapy becomes harder to fit in.

2. Spending increases—and therapy gets bumped down the list

Gifts, travel, childcare, and events stretch budgets thin. Many clients pause therapy thinking, “I’ll come back in January.”

3. Insurance deductibles reset soon

Clients with high deductibles often delay starting therapy until the new plan year.

4. Emotional avoidance intensifies

Holiday stress is full of triggers:

  • returning to difficult family environments
  • grief resurfacing
  • pressure to “hold it together”

Avoidance makes therapy feel “too heavy” for this season.

5. Illness, weather, and childcare disruptions spike

Winter in the Midwest means more last-minute cancellations.

How Therapists Can Keep Their Caseload Steady in December

✔ 1. Get ahead of cancellations

Use the first week of December to check in with clients:

  • “Are you traveling this month?”
  • “Do we need to adjust your schedule for the holidays?”
  • “Would telehealth help you stay consistent?”

Proactive planning prevents sudden gaps.

✔ 2. Reframe therapy as an anchor, not an obligation

Clients often underestimate how supportive therapy can be during the holidays. Gently encourage:

  • stress-management sessions
  • prep before seeing family
  • boundary-setting work
  • grounding skills for emotional overwhelm

Remind them: this is not the month to put their mental health on the back burner.

✔ 3. Offer flexible formats

A 45–52 minute session is not the only option:

  • Telehealth when traveling
  • Shorter check-ins when the schedule is tight
  • Pre-holiday “tune-ups”

Clients are more likely to stay engaged when therapy feels accessible.

✔ 4. Reinforce policies to stabilize billing

Even in a warm and compassionate practice like PBC, structure protects both the client and the clinician.

  • Send reminders about the cancellation policy
  • Encourage updated cards on file
  • Verify benefits for January now with the client
  • Remind clients of insurance changes or deductible resets

Clear expectations = fewer billing surprises.

✔ 5. Keep intake flow alive—with visibility

December can still bring new clients if you stay active:

  • Post more frequently on social media
  • Email referral partners
  • Include openings in your email signature
  • Highlight January start dates for groups
  • Re-share blog posts and group flyers

Sometimes people simply need to be reminded that therapy is available—even in December.

✔ 6. Use downtime intentionally

If your schedule softens:

  • catch up on charting and treatment plans
  • complete CEUs
  • refresh your specialty pages on the PBC website
  • prepare January social media content
  • build skills binders or session worksheets

Everything you organize now will make January easier.

✔ 7. Reach out to “quiet” clients

Lower engagement doesn’t always mean they’re gone. A simple:
“Hey, thinking of you—would you like to find time to meet this month?”
can re-engage someone who is struggling silently.

Helpful Resources

Practice & Professional Development

  • ZynnyMe: Therapist business strategy
  • TherapyNotes & SimplePractice Blogs: Scheduling, billing, and retention tips
  • American Counseling Association: Holiday-season best practices

Client Support Tools

  • 988 Suicide & Crisis Lifeline (Call or Text)
  • Illinois Warm Line: 866-359-7953
  • NAMI Holiday Stress Guide
  • Mental Health America Holiday Toolkit
  • SAMHSA National Helpline: 1-800-662-HELP

At PBC, we also encourage clinicians to refer clients to our groups or weekend openings—which often fill more easily in December.