At Grow Therapy, we believe it’s crucial for providers to be proactive about their clients’ mental health. In the same way that doctors do regular physical check-ups with patients, mental health checkups should be normalized and celebrated. That’s why it’s a small victory for mental health everywhere when a provider books a “maintenance” or “check-in” session with their clients.
But sometimes those sessions can feel a little, well, awkward. What do you talk about for 45 minutes when the client’s life doesn’t feel messy to them anymore? How do you make the time worth your session fee?
Also, how do you make sure the service meets the medical necessity requirements to receive payment from the payor? Most importantly, how do you reinforce the emotional health that led your client to feel ready to move on from weekly sessions in the first place?
With a little planning and some go-to questions, you can make sure maintenance sessions are invaluable to your clients — and enjoyable for you both.
Key takeaways
- Maintenance sessions feel awkward only when you go in without a plan — a little preparation and a few go-to questions make them valuable for both you and your client.
- Always start by asking what the client wants to discuss before defaulting to your own agenda — they may have been saving something for this session.
- Celebrating progress explicitly is clinically important, not just feel-good — it reinforces growth and builds confidence for the work ahead.
- Use the miracle question when open-ended goal-setting questions aren’t getting traction — it consistently surfaces what clients actually want and what’s standing in their way.
- End every maintenance session with a clear plan for the next reconnection — whether that’s a set date or a mutual understanding of when to reach out.
1. Prepare in advance
No one can blame you if you can’t recall all the details of the issues you discussed with your client last year. But that’s one benefit of your record keeping – when you’ve got a check-in session coming up, it’s time to pull up those notes.
If your notes leave a little something to be desired, you can prepare a loose script for the beginning of your next session. Try this:
“I just wanted to start our session today by asking if there was anything you were hoping to discuss or share with me in our session today – I want to make sure I am fully prepared!”
If their response still doesn’t jog your memory, practice this:
“I remember _____, but I can’t quite recall _____. Can you remind me?”
Remember that it’s okay not to remember everything and to ask for clarification and reminders throughout your session.
2. Set a collaborative agenda
Sure, it’s just a “check-in” session, but that doesn’t mean a client doesn’t have anything on their mind. In fact, they might have a few things they’ve been mentally saving to chat with you about. Make sure the first order of business is to ask them what they want to talk about.
Keep it simple:
“Is there anything specific you’d like to focus on today?”
“Has there been any moment in the last (time since last session) that you’ve thought, ‘I wish I could talk with (therapist) about this?’ Now’s our chance!”
“Before we dive into all the things I would love to get caught up on, is there anything you’d be disappointed if we didn’t get a chance to discuss?”
By asking this question, you might find that your session is automatically filled with conversation your client knows will benefit them. Don’t skip it!
3. Ask for updates
If your client doesn’t have anything specific they want to talk about, it’s time to reconnect.
Asking specific questions about things you remember serves a dual purpose: it helps your client feel known and seen, and it gives you the chance to detect how things have been going since you last met.
If your memory of the client’s life isn’t fresh, it’s a good time to reference the preparation you did before the session. Ask about specific issues or events they’ve mentioned in previous sessions.
For example:
“Last time we talked, you were having trouble with a neighbor. How’s that going?”
“When we worked together last, you had been experiencing a lot of ruminating thoughts. Are you still having that experience?”
“How are things at work since your promotion?”
If you’re not sure what to ask (and your notes didn’t prove helpful), try general questions:
“How’s your family doing?”
“What have you been up to since we last talked?”
“What’s the biggest change in your life since we met last?”
4. Reflect on progress and celebrate successes
It can be easy to lose sight of how far you’ve come when you don’t see your therapist cheerleader every week. That’s why it’s important to take a moment and reflect on your journey since the last check-in.
You can prompt them to measure their progress with some open-ended questions:
“What’s been going well for you since our last session?”
“Have there been any milestones you’d like to share?”
“Are there any areas where you feel particularly strong or confident?”
It’s important to celebrate successes, no matter how small. It reinforces growth and boosts confidence. If a client mentions that they’ve dealt with stressful situations better than before, or that they haven’t gotten back in touch with their toxic ex, let them know you’re proud.
Did you know?
Research on therapeutic alliance consistently shows that clients who feel their therapist remembers the details of their lives — not just their diagnosis — report significantly higher satisfaction and better treatment outcomes. Maintenance sessions are a rare opportunity to demonstrate that continuity of care, especially for clients who have reduced session frequency and may wonder whether they still matter to you.
5. Explore future goals
You know that just because a client isn’t in regular therapy anymore, doesn’t mean their work is finished. Mental health and emotional growth are lifelong processes. So once you’ve celebrated how far your client has come, it’s time to put the focus on the next stage of their journey.
Once again, let your client set the tone. Remind them that there’s nothing too small – or too big – to bring up. You’re here to support them in building their vision for their life.
Here are some ways to spark that conversation:
“What are you looking forward to in the coming months? Any big dreams or plans?”
“Are there any new goals or projects you’re excited about? Something you’ve been itching to try?”
“How can we build on your current wins to help you achieve these new goals?”
If none of these questions resonate, you can always try the miracle question:
“This may seem strange, but stick with me. Just imagine going about your normal day and going to sleep.
During the night, something happens – a miracle. A big surprise awaits you the next day.
A big change has happened in your life, and it’s just what you have always wanted it to be.
What would be the very first difference you would notice in your life?”
This tried-and-true question can help you figure out what areas your client might still need support in.
6. Address minor concerns
Dreaming about the future sets the stage for discussing the barriers, big and small, that might be standing between your client and the future they want. As their therapist, maintenance sessions are a great opportunity to help them do some “weeding” in terms of little (or big) things that might be crowding out their growth.
Here are some questions to help you detect what might be standing in their way:
“Are there any aspects of your life that feel a bit off or out of balance?”
“Have any old patterns or issues resurfaced that you’re struggling with?”
“Is there anything you’ve been avoiding or unsure about how to handle?”
If open-ended questions don’t seem to get an answer, try delving back into your clients’ response to the “miracle” question:
“You said that you’d like to have a better relationship with your mom. What do you feel is the biggest reason that’s not happening now?”
“You said that you want to be healthier and more active. What challenges are you facing in making that a reality?”
7. Reinforce coping strategies
For the most part, the answers to the struggles your client is facing now are probably already in their toolbox since they already graduated therapy. Encourage your client to recall what worked for them then, and help them figure out how to apply those coping skills to the new situations they’re facing.
For example:
“Remember how practicing mindfulness helped you manage stress during your last job transition? How might those techniques help with the new challenges you’re facing at work now?”
“You did a great job using assertive communication to set boundaries with your friends before. How could those same skills be useful in your current relationship?”
“When you were feeling overwhelmed last year, you found that regular exercise and journaling made a big difference. Are those habits something you could reintroduce now?”
“Last time, breaking problems down into smaller steps really helped you tackle big projects without feeling overwhelmed. Could we apply that same approach to your new goals?”
8. Schedule your next reconnection
You’ve probably learned enough from this session to know how your client is doing, and whether they could benefit from more regular sessions. But it’s still up to them – make sure they know you’re available, but give them an idea of what you think you could offer them in terms of support.
Here are some ways to approach it, depending on the situation:
“It sounds like you might benefit from talking again sooner rather than later! Would you be interested in meeting regularly again?
“Let’s schedule our next check-in now. How does three months from today sound?”
“When would be a good time for us to reconnect? We can set a date now, or I can reach out closer to the time to arrange it.”
“I know you’re focusing on a lot of new goals. How about we schedule our next session for when you think you might need a boost or some extra support?”
Maintenance sessions are a golden opportunity to support your clients’ long-term mental health and well-being. By preparing in advance, setting a collaborative agenda, and focusing on both successes and challenges, you can make these sessions worth the time and effort your client puts into setting and keeping them.
How do I document a maintenance session to meet medical necessity requirements?
This is one of the most practical concerns providers have about check-in sessions, and it’s worth addressing directly. Medical necessity for outpatient therapy typically requires documentation showing that the client continues to have a diagnosable condition, that treatment is likely to improve their functioning, and that without continued care there is a reasonable risk of deterioration.
For maintenance sessions, the key is documenting not just what was discussed but why continued care — even at reduced frequency — is clinically indicated. Useful language includes noting the client’s current symptom levels relative to baseline, any areas of vulnerability or stress identified during the session, coping skill gaps that were reinforced, and a clinical rationale for the recommended interval before the next session.
A brief note that explicitly connects the session content to the client’s ongoing diagnosis and treatment goals gives the payor what they need. If you’re unsure about your specific payor’s documentation requirements, check the clinical guidelines in your Grow provider portal or reach out to Grow’s billing support team.
Final thoughts
Maintenance sessions are one of the clearest expressions of what good long-term therapeutic care actually looks like — not just crisis management, but active investment in a client’s ongoing growth. Providers who do them well tend to have higher retention, stronger therapeutic alliances, and clients who return without guilt when life gets hard again.
The eight steps in this article give you a framework to work from — but the most important thing is showing up prepared and genuinely curious. Clients in maintenance mode can tell the difference between a perfunctory check-in and a session that actually serves them.
