While recently updating our business practices, my colleague and I had a lengthy conversation regarding cancellation and no-show policies and related fees. I became curious how others, both clinicians and those seeking therapy, feel about this sometimes seemingly taboo topic.
Let me first state my practice’s policy: We request 24 hours’ notice for cancellations. Cancellations made prior to this window are rescheduled with no penalty. Cancellations made without 24 hours’ notice but prior to the start of the session incur a $50 late-cancellation fee. No-shows or cancellations made after the start of the session incur the full fee.
I’m curious what people’s reactions to this policy are. My guess is some may find it too harsh, while others may find it too lenient or too complicated. Many mental health care practitioners’ policies include charging the full fee for any cancellation within a 24- to 48-hour requested window of notice.
For a long time, I had a hard time justifying collecting money, especially the full fee, for what ultimately amounted to me ending up with “free” time. But as I gained experience, missed appointments added up to a significant loss of income, and I came to recognize that the potential for frustration and resentment was not healthy for the therapeutic relationship.
Knowing I needed to find an effective and fair solution, I decided upon the above policy. My rationale included several factors, the first involving the recognition that the people who choose to work with me are ultimately paying for my time. In general, individuals in therapy tend to come to weekly or, sometimes, every-other-week sessions. Their session time is carved out in my calendar and set aside just for them. If somebody cancels with some notice, I know I have an open hour. I can schedule another appointment, run out and do an errand, or peacefully return calls without watching for a potential latecomer. I have had a hard time charging people a full fee in this situation. The $50 fee for less than 24 hours’ notice, however, feels like a fair compromise. It’s like collecting a deposit to have held the session time.
On the other hand, if someone doesn’t show up at all or communicates a cancellation after the start of the session time, I’m stuck waiting to see if they are running late. At about a quarter after, I spend time trying to get in touch to follow up and reschedule. It doesn’t leave me the freedom to be truly productive with the time and minutes left until my next appointment. Thus, I’m better able to justify collecting a full fee in these instances.
I understand stuff happens—projects at work pop up, kids get sick, tires go flat. Most people respect the policy after a gentle reminder and tend not to have frequent last-minute conflicts or cancellations arise. However, I found that routinely not charging for late cancellations sets a precedent some people end up taking advantage of, and I’ve noticed a trend where the people who cancel late or no-show tend to be chronic offenders.
I understand stuff happens—projects at work pop up, kids get sick, tires go flat. Most people respect the policy after a gentle reminder and tend not to have frequent last-minute conflicts or cancellations arise. However, I found that routinely not charging for late cancellations sets a precedent some people end up taking advantage of, and I’ve noticed a trend where the people who cancel late or no-show tend to be chronic offenders.
The more I contemplated whether it is fair to charge a late-cancellation fee, the more I came to understand that implementing some penalty for late cancellations and no-shows is an important part of the broader scope of the therapeutic work. People seek therapy to improve their overall quality of life, and those who frequently cancel or fail to show up for appointments often demonstrate issues with commitment, accountability, and responsibility in other areas of their lives. I ultimately realized I am doing the people I work with a disservice if I enable them to avoid facing responsibility, and that I am failing to help them develop an understanding that the real world has consequences to various choices and actions.
Instead, I want to model healthy and clear boundaries and empower people to be responsible in their lives and assertive in their ability to communicate regarding their circumstances. Therapy is about helping people to develop a sense of awareness about themselves and how their actions impact those around them.
Therapy tends to be most helpful to people who view their appointments as an important and valuable component of their lives. And for most people, money equals value. When people are willing to make therapy a priority and accept the financial commitment involved, they tend to experience greater and quicker growth and positive change.
Discussion regarding money can be an uncomfortable topic, especially in a therapeutic relationship where connection, support, and compassion are paramount. The collection of money for services—rendered or not—sometimes feels contradictory to the nature of the work, and it is often difficult to navigate the line between the professional and truly caring ends of the relationship. But the handling of and attitude toward these finer details of business are important to the process and worth consideration for all involved. Being confident in and mindful of boundaries and policies, paired with the ability to broach uncomfortable topics, is often where true trust, authenticity, and connection develops—and these are the components that make therapy genuinely helpful.
The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the preceding article can be directed to the author or posted as a comment below.
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