Why I Charge for Late Cancellations and No-Shows to Therapy

Person works at business desk with alarm clock in sharp focus in foregroundWhile 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.

© Copyright 2016 GoodTherapy.org. All rights reserved. Permission to publish granted by Megan MacCutcheon, LPC, GoodTherapy.org Topic Expert Contributor

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.

  • Leave a Comment
  • Cora

    September 21st, 2016 at 7:08 AM

    Well why not?
    Your time is money, same as hair dressers and anyone who works on an appointment basis

  • Claire

    September 21st, 2016 at 10:07 AM

    I too will charge for missed appointments, but typically not full price and only those who are repeat offenders.

  • ben

    September 21st, 2016 at 2:12 PM

    Well I am not for this at all! I think there are times when you legitimately have to cancel and sometimes that cannot be within that magic 24 hour window. I would probably end up going to someone else if they charged me like that.
    Ok so I can see it for someone who is a habitual offender but one or two time? Not cool.

  • Bill H

    September 22nd, 2016 at 7:18 PM

    Most therapists, unlike MDs or dentists, make allowances in cases of real emergencies. Even missing once or twice without giving notice is an indication of something that needs to be addressed in the relationship between therapist and client. By not giving proper notice, you are essentially stealing an hour of the clinician’s time. That’s really not cool, unless there’s a significantly important reason for doing so.

  • Harold S.

    September 23rd, 2016 at 5:25 PM

    If you buy tickets to a concert, and are unable to attend for any reason, the concert venue does not provide a refund. There are those patients that have genuine emergencies. And there are those who do not respect therapy and are continually late, and make excuses for being late. If someone no-shows, the therapist is out time and money. Another patient could have been scheduled. I am changing my policy to first short notice cancellation, things slide, and then after that, a strict policy of full session fee for cancellation within 24 no matter the reason.

  • Mike

    September 23rd, 2016 at 8:19 PM

    My therapist has a cancellation fee, but has always waived it when I’ve been sick, and even better he tries to work me in over the next couple of days so I don’t miss a whole week and he still gets his income (win-win). I feel that it’s necessary to set boundaries and have consequences, otherwise the therapist is not helping me to better meet life challenges outside the session. If the therapist clearly conveys caring and empathy, I think most clients can see that he has their best interest in mind. A therapist is not supposed to hold your hand and say lovely things all the time. But of course, my opinion is that a therapist can convey unconditional care and positive regard through it all. And not every client is ready to be thrown out of the nest. Early in therapy, he extended himself a little more and gave me a little more freedom without consequences, which I think was appropriate, but he doesn’t treat me with kid gloves any more.

  • John S

    August 11th, 2019 at 10:27 AM

    I track my clients. A real situation every once in a while is an acceptable with a client who is truly engaged in the therapeutic process. However, many clients seem to feel that showing up is optional. In these situations, I’ve failed to communicate the boundaries of therapy. These clients also tend to not be engaged in real change (e.g. precontemplative with regard to their suffering).

  • Ed B

    October 17th, 2019 at 8:23 AM

    “I would probably end up going to someone else if they charged me like that.” You mean, of course, if you can find a therapist who does not charge for late cancellations and no-shows. Good luck with that.

  • Dixie

    December 15th, 2019 at 8:04 AM

    It is my policy to charge the full amount if I do not get a call within 24 hours prior; I do however take into consideration the reason that they could not make it, and then I chose weather or not to waive the fee.

  • Bill

    September 12th, 2023 at 5:58 PM

    The therapist has to sit there for an hour and twiddle their thumbs, and they have to pay rent on that hour, and if it happens a lot it means their salary fluctuates wildly and they can’t get a mortgage. There is no way to put another client in that spot, because that’s your spot, even if you cancel 2 weeks in advance they can’t just get someone in for that one hour. So if on some occasions they charge you and you can’t stand that and leave, maybe that’s something to talk about with your next therapist.

  • Annetta

    September 22nd, 2016 at 8:01 AM

    I guess you have to look at it as they are not making any money for the day when patients constantly pull a no show on them. That is not fair to anyone. If you go to work to do your job and you are there then you expect that you will be paid. People cancel at the last minute or even worse don’t show up, then how are they supposed to make a living and recoup some of those lost charges? I say yes, if you are fair and thoughtful about it, then I see nothing wrong with it.

  • Jennifer

    May 17th, 2018 at 4:08 AM

    How are they supposed to make a living? Er, by you rescheduling for another time. Are you saying that every single therapist is booked up eternally? NO. They have revolving clients and the best way to recoup your missed appointment is to replace it with an alternate time, no loss to the therapist. It’s not like a hotel that can only be charged at a specific time and date, and this is a genuine loss for a no show. But as a patient, I am not essentially a ‘no show’ if I reschedule my missed appointment. It’s not a ‘missed’ appointment, it’s a moved appointment. Any patient who wanted that time, would have found an alternative too. It could only be a missed or lost ‘patient’ and its very unlikely that a therapist would really lose a patient just because they can only book times that are currently available.

  • Jennie, LMT

    August 7th, 2018 at 8:12 AM

    Sometimes a reschedule can be a loss to the therapist if they count on that $ that particular $ that week.

  • Sal

    November 17th, 2018 at 9:20 PM

    Yesterday I had 4 clients who did not show up (either with less than 24 hours notice, and one just did not arrive). I still have to pay rent for the room. I drive nearly 2 hours to this rural practice once per week (and pay to stay the night). I did not receive any income, and it cost me both money AND time away from my 4 children and husband. I have not been enforcing my cancellation policy (as I am aware that these people are low-income earners), but I am now changing my practice. My business cannot sustain no-shows…

  • Keyonne

    October 2nd, 2023 at 3:10 PM

    Rescheduling is still a loss of income to the therapist. Therapists rely on the appointments they have each week for their income. If clients cancel or even reschedule, that income can not be counted for that week. Even in some instances when they reschedule the same week. It all depends on when billing is done. So, even though you say the client has rescheduled so income is not lost, it’s still lost income and will be missed by the therapist.

  • Maura

    September 22nd, 2016 at 10:50 AM

    I think that it is the rudest thing ever to have an appointment somewhere and then not even take the common courtesy to cancel the appointment if you are not going to show up.
    We have no shows in our office all the time and then people wonder why we sometimes double book. It is because there is still a large majority of people who will make an appointment and then not bother to show up.
    What are we supposed to do, twiddle our thumbs and still hope that magically the money will be generated to pay us?
    Nope you sort of beef up the schedule a little bit and then when everyone shows up you just sort of bust your tail that day to have them all seen.

  • Karen

    September 22nd, 2016 at 11:43 AM

    This is a tough subject because therapy is a very vulnerable process. I have been in therapy for 9 years now, and I have yet to call in once or show up late.. not one session have I missed .. but if for some reason I didn’t show up and didn’t give notice, I would take offend to being charged because its not like me to not show up. I would have to say that, the best way to handle this is maybe to look at it as a person by person situation. I would charge only those who make this a habit or take this time for granted.. but for someone like me, or someone who is really dedicated to the process, I would really be more curious about it and talk to the client about it. I think its harsh to penalize a while session price especially if the person is not one to call out or be late.

  • Megan MacCutcheon, LPC

    October 1st, 2016 at 6:09 AM

    I totally agree with you, Karen, that it ultimately is enforced on a case-by-case basis. If somebody with a history of being incredibly reliable doesn’t show up once, I would definitely be worried and of course would cut that person some slack. You can definitely stray from the policies and make exceptions as necessary – the hard part is coming up with a policy that will be fair and comprehensive in order to have clear and consistent expectations up front. The opposite of that is making up the rules as you go, which isn’t fair. But yes, there will definitely be times where exceptions are made!

  • Radonna N

    September 22nd, 2016 at 12:47 PM

    I can’t imagine not showing up. I have never even been late. I didn’t see how you cover illness but even when I’m sick I FaceTime my therapist. My time with her is not replaceable and I would never want her to give away my appt slit or replace me so I respect her. I can see how your time is money but I can’t imagine not showing up.

  • Kathleen

    September 22nd, 2016 at 6:15 PM

    It’s not legal in my state to charge a Medicaid patient a fee for a missed appointment for any reason. Many private insurance companies do not allow for this either. It’s really only in a cash pay situation that a therapist can do this.

  • Danielle

    September 23rd, 2016 at 8:46 AM

    How does this work with clients on public medical insurance (Medical Assistance, MNSure, Medicare…)? Are clinicians allowed to charge those individuals?

  • Harold S.

    September 23rd, 2016 at 5:28 PM

    A therapist may not be able to charge a Medicare patient for a missed session, but the therapist can discuss the issue of missed sessions and short notice cancellations and make that part of therapy.

  • Sher

    August 26th, 2017 at 11:01 AM

    I am an in-house biller for a psychology & therapy clinic and you may not charge a medicaid patient missed appointment or no-show fee. However, you CAN charge a Medicare patient a fee. cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM5613.pdf

    We’re implementing a cancellation policy due to chronic no-shows & last minute cancellations. Some patients are medicaid so we’re discussing limiting no-shows/last minutes to a certain amount and then they’ll have to find another place. It’s a matter of holding people accountable and respecting the service we’re providing. We’ve had so many days where a therapist is booked from 8am – 5pm on a Saturday and the first and last appointments show but all the ones in between late cancel or no-show. So the therapist has to sit there all day just for the last appointment. It’s incredibly disrespectful. When there are no consequences, the negative behavior continues…thus the pattern doesn’t cease. This is a business and yes we provide a much needed service but we have bills to pay, payroll, taxes, etc and we can’t do that when we don’t have enough time to fill an appointment without enough notice.

  • Teri

    September 23rd, 2016 at 10:21 AM

    but you can refuse to see them again if this is a pattern of behavior.
    that is your prerogative correct?

  • Lauri

    September 23rd, 2016 at 10:11 PM

    My therapist has this policy-one with which I agree-and he also applies something similar in the reverse. If he misses a session because he made an error with scheduling, he will reschedule me ASAP and will not charge for the rescheduled session, because it was his error, and it inconvenienved me. He does other things like that so that the policy os applied both ways. This shows respect for both the therapist’s AND the client’s time.

    However, regardless of his practice applying this policy in reverse, I would still feel obligated to pay for his time if I did not cancel within 24 hours. I feel concern for other patients who may have really needed that time, which instead was not dedicated to patient work. Paying my therapist reminds me of the significance of my missing the session (which would require that I be on my death bed!). It also simply feels respectful of his time. I understand the negative reactions, also. For me, it can seem like one more way in which my therapist has more power than I in the relationship. I wonder if this is just one more way in which my therapist has more power than I. The imbalance of power that is necessarily part of the therapeutic relationship always results in the most frustrating dynamics, frustrating interactions and “policies.” Just a thought.

  • Bill

    January 17th, 2017 at 8:29 AM

    I think that it’s important for mutual accountability. As a clinician, I do the same thing as Lauri’s therapist. If I miss a session, except in case of a dire emergency, I will re-schedule with the client as soon as possible and not charge them for that session. I believe this fosters a sense of justice and equality in the therapeutic relationship – and it’s certainly how I’d want to be treated in such an instance.

  • Ross

    September 24th, 2016 at 8:18 AM

    People who are professionals themselves will understand the importance of giving someone enough time to fill this space on their schedule and should respect the right of someone to ask for compensation when they are not given this courtesy.

  • grace anna

    September 26th, 2016 at 10:16 AM

    You sort of have to start out probably a little more accommodating to those things when you are first starting a business. But you know, as the business grown and you are more in demand, then you have to do what keeps your income level as well as your patients happy.
    I think that you probably have to walk a very fine line between those two things.

  • Jennifer

    May 17th, 2018 at 4:20 AM

    But have you really ‘lost’ money if you simply move the appointment to a later time, have you not just delayed your payment? Unless the no showing patient never comes back, if they just reschedule asap, then you will recoup anything they would have paid in the original appointment. Anyone who wanted that timeslot the no show missed, would have found another time so it’s not really a loss as long as you don’t lose the actual patient, it’s only the appointment moving around. It’s not the same as a hotel which is a loss because it can only be held at that particular time.

  • Megan

    May 19th, 2018 at 1:02 PM

    The problem is, it’s not always easy to just move an appointment to another time or day. Sometimes it’s possible that today doesn’t work, but there’s a time that works for both parties tomorrow. But it’s not always that simple. 1.) The therapist could be booked the rest of the week; 2.) What if the session was for a Friday and it’s the end of the week and it’s a client who comes weekly? You may not be able to reschedule that week’s session within that same week.

    Some therapists don’t charge if you reschedule within the same week. I personally saw a therapist who had that as a policy but I found that almost more annoying because it was hit-or-miss whether I’d be charged if I had to reschedule. It was up to chance – chance that she would have another opening in her schedule that week or that her other clients wouldn’t have already filled any openings/other cancellations. I prefer to know what to expect.

    There are just so many factors involved in whether you will have the option to reschedule and it really depends on each therapist and his/her schedule, number of days in the office, etc. I think some clients assume therapists are in their offices all day with free time- But sometimes that’s not the case. Many therapists are only in their office a few days a week and have schedules filled with back-to-back appointments and few cancellations. Sometimes, adding your reschedule into their schedule means adding another hour to their day, missing a lunch break, coming in on their day off, etc. which is not always convenient. You also have to think about the expense to the therapist – They are likely paying for rent (by the hour or day), utilities, and possibly childcare. Rescheduling for another day could result in additional expenses on their end, not to mention the extra time involved in communicating regarding the missed appointment and rescheduling options. This is minor for one cancellation here or there…But when you have several cancellations occur in a week or month it can take it’s toll on the therapist’s business and work-life balance. Charging for cancellations and no-shows is not something most therapists enjoy doing; however, it is part of running a successful and self-respecting business.

  • Pamela

    September 27th, 2016 at 10:57 AM

    You have to look out not for just your people that you work with but you also have to look out for yourself. The bottom line is that you have to be able to pay your bills too, just like everyone else does, so in order to protect that then you might have to at times make some tough choices and business decisions. They might not always be popular, but again, you have to protect your personal interests.

  • Heather

    September 1st, 2017 at 12:57 PM

    My daughter’s psychologists charges the full cost of the appointment plus an additional $50 no-show fee. I pay a month in advance for the full cost of all the appointments. With the start of school, I spaced out on her appointment, and missed it completely. Totally my fault. I’m aware that I need to compensate her for my mistake. However, when I paying her in advance her full rate with no insurance, it seems odd to add an additional fee.

  • Galen Cole

    January 7th, 2018 at 8:53 AM

    Thanks for sharing. I just tweaked my policy to align with yours. Whereas I used to charge $35 for the first “no show” or late cancellation, and the full amount ($225 per hour for subsequent sessions), I have now raised my first time fee to $50. My logic is simple…I can easily fill a slot if I have enough notice which means that if I don’t have notice I lose $225. This is not ok since I’m in private practice and I have lots of expenses just keeping the doors open.

  • Jill

    May 17th, 2018 at 4:31 AM

    As long as the patient rescheduled how have you lost anything? You would have to lose the patient, not the appointment to lose money. Any other patient who tried to book at that time would have asked for the next available, so unless you are losing patients who can’t get that timeslot that was missed, you haven’t really lost any money. It’s only if you are saying that a no show for one appoitment changes your actual clientelle that it would have an impact. I regularly showed up for therapy and then due to a lot of stress going on I completely forgot my appointment. I have never been disrespecful of my therapists time and had no intention of repeating it, the punishment was that I didn’t get to see my therapist as I had been looking forward to it and was very disappointed that I had gotten so distracted. However, I got charged the FULL amount, which is normally discounted with a rebate, which doesn’t apply for no shows. It was extremely hard to swallow when they called a month later to take the money for an appointment I never got and it really changed my relationship and feelings about going there. I don’t need to be treated like a naughty child and it felt really disrespectful to be treated like that just because I missed one appointment. I had been ongoing for a long time and was worth a lot of money to that clinic, now I’m left feeling bitter and insulted and considering if I want to return.

  • Megan

    May 19th, 2018 at 1:22 PM

    I would encourage you to see your therapist again and discuss how the experience of being charged made you feel. In this case, it sounds like it was the clinic / a billing staff contacting you for payment (and just following the procedures you probably initially signed), so your feelings might be toward the clinic, not the actual therapist. But either way, sometimes, the best insights and growth come from discussions in therapy regarding conflict or ruptures in the therapeutic relationship.

  • Jennie, LMT

    August 7th, 2018 at 8:21 AM

    As a LMT, even with a reschedule, it can hurt when you expect that $ that week. The $ that comes into me, helps me feed my children and clothe them and pay for bills. So if there’s a reschedule it still can hurt in significant ways. Something to keep in mind. Having a policy in place is not for some people, it’s for everyone.

  • Michel

    June 23rd, 2019 at 5:24 PM

    If a client reschedules and expects not to pay for the cancelled session, the therapist has now blocked out two hours and is only getting paid for one. If I’m in my office and someone cancels their 5pm session at noon, if I can’t fill it, it’s a wasted hour, and then I need to see them again?
    Clients should pay for missed sessions unless there is an emergency. Whether you charge a fee or the session fee, it’s completely justified.


    May 30th, 2018 at 11:34 PM

    I missed an appointment because my therapist made, what I believe to be, an error in judgment in how she approached an issue of concern, which caused me to feel anxious to come back. I told her the day before in an email with 22.5 hours before my appointment my feelings of apprehension. She went ahead and charged me anyway, further putting a rift. This after I’ve been dependable for at least 4 years with her. I told her I didn’t feel it was fair to charge me the full penalty ($100) because I believe she had a part in why I missed the appointment. I don’t know how this is going to turn out. I feel very hurt. I’ve been a loyal client and appreciated her until the past few weeks it’s been bizarre.

  • Megan MacCutcheon, LPC

    May 31st, 2018 at 8:25 AM

    I’m really glad you shared this and that this post continues to get so many comments with personal examples because it really highlights what a touchy subject this is and how much grey area there is regarding cancellation policies.

    It’s important for therapists to have clear cancellation policies because they are, at the end of the day, running businesses. But I believe there absolutely needs to be some flexibility for situations like you described. I can see how you would feel doubly wronged here – being charged after a rift AND when you were so close to being within the 24-hour window.

    Some therapists are really strict about the 24-hour period and others are more lax. I personally don’t count down to the minute – Of course, the more notice the better for the therapist to be able to fill that slot, but if you let me know the day before, I consider that enough notice to not be a “late cancel” with a charge.

    I’m so sorry you experienced this – A rift in the relationship can really feel like a major setback in your therapy; however, it can also really be a chance for BOTH the client and therapist to learn and grow, especially when the rift can be effectively addressed and worked through.

    I would encourage anyone in a situation like this to have another session with the therapist and discuss how you feel. It’s so important – not only for you to express your feelings, practice assertiveness skills, stand up for yourself, etc. – – But also for the therapist to gain more insight into how the “business side” of their interactions impacts clients and the therapeutic relationship.

    Sometimes, working through a rift in the client-therapist relationship can be a real turning point in therapy that can open you up to all kinds of growth, insight, and connection that can help foster deeper work. However, if the therapist does not seem open to your feedback and does not validate your feelings and ultimately help to resolve your feelings of discomfort, then it’s definitely worth finding a new provider, as a positive connection between therapist and client is the #1 most important factor in whether therapy will be helpful.

    So bottom line is I encourage you to have another session to see if you can repair the relationship. And if not, don’t feel bad about finding somebody who feels like a better fit. Sometimes it IS time to move on and makes changes in your therapy journey!


    December 24th, 2018 at 3:31 PM

    It’s been awhile since this happened. I had another appointment, but the whole thing turned disastrous. She terminated me. I feel the whole situation was handled very poorly. This after over 4 years of me being a good client and trusting her fully. She attempted to set some boundaries, which I fully believe were unfair…not really boundaries, but rather walls. I can’t for the life of me understand why she took such a hardline stance after all this time. I keep hoping someday she will apologize for her part in this. I really trusted and appreciated her. But I suppose there are too many legal fears for her to reach out and apologize. I’ve run this by other people, and I know she handled all this very poorly. If anything I wish a therapist could step up and admit their part in a conflict and try to set it right. Even several months later I feel extremely hurt. I attempted to try a new therapist, but it felt all wrong. Thankfully I do have a friend who is a retired therapist so can consult with him and that feels right. But I wish she would take initiative to right her wrongs. She did this at a very fragile point in my life.

  • Jennifer

    September 9th, 2019 at 12:50 AM

    You say ‘it’s not always possible to move an appointment’, am I hearing right? That doesn’t seem to make any sense. Of course you can move an appointment, the same as you make the appointment! How do you ever make appointments? If someone ‘no shows’ then they are obviously going to have to wait until whenever the next free timeslot is. Sure, you may be fully booked for a week or so, but that wasn’t my comment. The ‘no show’ will simply have to wait for the next available like any other patient, but please explain how you have lost money if someone makes an appointment at the next free slot? It actually IS that simple.

  • Jill

    September 11th, 2019 at 8:44 PM

    Jennifer – How they lose money is pretty simple math:
    If a therapist charges $100/session and has 10 sessions in a week, she makes $1,000.
    If she has 9 sessions in a week, she makes $900.

    You are not valuing the therapist’s time:

    If a therapist schedules 10 sessions in a week and everyone shows up, she’s in the office for 10 hours and makes $1,000.

    If she schedules 10 sessions in a week and one person late cancels or no-shows and isn’t charged a fee, she is still in the office for 10 hours but makes $900.

    If she schedules 10 sessions in one week and one person late cancels but reschedules later in the week, she spends 11 hours in the office (plus time communicating regarding the reschedule) and makes $1,000.

    But regardless of whether she makes $1,000 or $900, she still has to pay rent and other expenses for the time in the office, which, depending on her lease, childcare needs, commute, etc. could INCREASE if she adds that 11th hour in to accommodate your reschedule.

    Time = Money.

  • Marissa

    October 8th, 2018 at 3:09 AM

    I would like to know if its legal okay to charge the full price for a therapy session what is canceled way in advance like days. I understand the 24 hour policy but I get still charged even if I cancel a week ahead. This is a verbal agreement made on my low point in life. what to do?

  • Megan MacCutcheon, LPC

    October 8th, 2018 at 8:43 AM

    Marissa – Most therapists seem to have a 24-48 hour window cancellation policy, but I do know of one who requires a weeks notice. She does, however, try to be very accommodating in terms of rescheduling within that same week. If your therapist charges for appointments cancelled that far in advance without giving you much option to reschedule, I would think that is unfair and unreasonable. But it’s not illegal if it’s in his/her policy. All therapists should have their cancellation policies very clearly stated, with clients reading and signing prior to starting therapy. It is important to understand the policies ahead of time. Unfortunately, many people are in the habit of not reading the policies before they agree to them. I would ask your therapist to review the policy with you so you are clear as to exactly what to expect. If the therapist doesn’t have the policy in writing, I would question their ethics/professionalism.

  • Marissa

    November 20th, 2018 at 3:26 AM

    Thank you for your comment.


    November 19th, 2018 at 10:39 AM

    I am part of a practice that does charge for no-shows and late-cancels. I do routinely hear patient complain that we are “all about the money.” When I was a younger clinician, I would bend over backwards to dispute this. However, having had some years to grow more comfortable in my role, I no longer react this way, because yes, it IS about the money–at least somewhat. We are here for many reasons, but we are running a business at the end of the day. If we cannot generate income, we cannot sustain the business, and then we are unable to serve our patient/client population.
    Everyone’s time is important, and everyone has emergencies. But if we waved a cancel fee for every emergency, then we would be underwater quickly.
    My feeling is that every consumer deserves one pass–after that, even in what would be considered a legitimate emergency, the charge should be applied. This takes the guess work, guilt, and subjectivity out of deciding who and when to charge.
    Just to flip the scenario–I have worked FFS roles where I spent 8 hours in the office and was ultimately paid for only 3. If this happens two or three days per week, I am in a bind. I cannot tell my mortgage company or my childcare provider that my clients didn’t show up and my payment will be late, or short. I am still responsible for my bills. This made life very difficult, and it’s why a lot of good providers leave these types of positions, where there is no way to hold clients accountable and the clinician has to eat the costs of missed appointments.

  • AAArt

    January 15th, 2019 at 2:30 PM

    My psychiatrist and me were transitioning from a 90 minute appointment to a 60 minute appointment. We never spoke to whether the new appointment would start on the hour or the half hour. The first appointment was scheduled on the hour but on a different day because she had a conflict. The next week I showed up on the hour and she said I was late. She had no client one half hour before or after me. I am always on time and rarely cancel. I wanted to end the session in the 20 minutes remaining and pay half since it was a mutual misunderstanding. She disagreed. How can I continue with her?

  • Megan MacCutcheon, LPC

    January 20th, 2019 at 12:09 PM

    Hi AAArt – Wow, that does not sound right! If you had scheduled on the hour, and never implicitly discussed the session was (in her mind it sounds like) supposed to start on the half hour, I do not see how you were late! So sorry you had this misunderstanding and felt penalized. I hope you and the psychiatrist can discuss it further at the next session and work it out. I encourage you to be assertive about how the incident impacted you and made you feel reluctant about continuing your work together. Perhaps the psychiatrist (who is human and, thus, not perfect!) was having a bad day but will be in a better place to discuss this with you in the future. Keep us posted on what happens!

  • Lisa

    February 28th, 2019 at 11:02 PM

    I’m not ok with 24 hours in advance. A lot can happen in 24 hours. Sometimes you just can’t give 24 hours. What about considering case to case? I realize this could be costing them money,however my particular therapist charges 35,which is not an extreme amount but for those on a fixed income it very well may be. Not saying if your on a fixed income you shouldn’t pay, but perhaps less or even waived the first time.

  • Mike

    March 1st, 2019 at 10:44 AM

    Lisa, my own therapist requires 24 hour notice for things that are under my control, but doesn’t charge for cancellations for emergency reasons or sickness. I agree with you that sometimes you can’t give 24 hours notice, but the point with most therapists (I would hope!) is that they would charge for things that you *should* be able to give 24 hours notice about, like ordinary plans.

  • Mychal

    June 2nd, 2019 at 1:19 PM

    i have spa providers that are paid per services. If a client cancels less that 24 hours how do you pay your providers? The full services amount? A percentage of the cancellation fee? other?

  • Amy

    September 24th, 2019 at 7:57 AM

    As a psychologist this is a topic that I have struggled with. There seems to be a fundamental difference, in my mind, between a cancelled appointment and a no-show. In general I tend to be more lenient about cancellations because “stuff happens” and the vast majority of those people eventually reschedule, usually within an amount of time that will allow me to recoup any lost fees. However, I am more inclined to bill for no-show appointments so as not to reinforce a potential attendance problem. Talking with clients during the intake session about the no-show billing policy helps to keep it transparent so there are no surprises. I realize that this is my policy and it may not work for everyone.

  • Jack

    October 3rd, 2019 at 11:09 AM

    I just found some charges that were submitted to a collection agency on my credit report from a therapist’s office that I visited almost 2 years ago. I visited the office once and had arranged to follow up every Monday thereafter; however, a few days later I called to cancel all future appointments because I lost health insurance. I even paid a cancellation fee during this phone call, which was days in advance of the appointment. Apparently they decided to keep charging me for no-show appointments, and now it’s on my credit score. I may be undergoing a security clearance soon, and this will show up, and am definitely considering legal action.

  • Les

    December 2nd, 2019 at 7:57 PM

    How do you feel about a therapist that repeatedly charges late fees over and over again for the same report, even when the fees were paid only an hour or two late. Then charging another late fee on the late fee even when she has been paid far more than the original cost of the service. Doing this to a family that has little money and has caused severe strain in that family as they have to borrow money from relatives to try and keep their kids. Meanwhile, the therapist wants more late fees, knowing the damage they are doing to that family. Is that ethical ? Or do therapists have no duty to do no harm ?

  • Megan MacCutcheon, LPC

    December 3rd, 2019 at 8:04 AM

    Les – Not sure if you mean that the therapist is charging a late payment fee on top of a fee for a missed session? Or they are charging accumulating interest on outstanding bills? It’s one thing to charge a late cancellation fee and to charge interest on outstanding balances, but you should not be paying the same fee multiple times. While it’s important for therapists to have policies to collect payment and successfully run their businesses, I do think there has to be some room for flexibility and sometimes therapists do have to write off outstanding balance that will never get paid. If somebody I am working with has accumulated an outstanding balance for more than three sessions, my policy is to not reschedule with them until we can get the balance paid or discuss a payment plan. Issues surrounding money and unpaid balances can negatively impact the therapeutic relationship and thus the work in sessions. If unpaid balances become an issue, I think the therapist has a duty to discuss the issue with the client, try to work out a plan together, and make referrals to lower-cost treatment as necessary.

  • Michael

    January 8th, 2020 at 4:33 AM

    Therapeutic relationship. Mutual consent. Though the therapist is the helper, the relationship is still based on MUTUAL trust and respect. Most of us spent 10+ years before we found ourselves in private practice. My time is valuable. I am good at what I do. REALLY GOOD. If a client does not communicate more than 24 hours they will be missing an appointment it affects 3 parties: 1) The client (they don’t get help) 2) the therapist (they don’t get paid) and 3) another potential client (can’t schedule in time). It is MORALLY responsible to have this policy and to enforce it for the betterment of ALL!

  • Ozashk G

    September 9th, 2020 at 8:27 PM

    I’m a creative arts therapist in my second year of practice and although I have a policy of 24hrs notice, I’ve been flexible with my clients in general. My bhusiness advisor will tell me that I’m running an business and that although it’s a ‘helping’ service, I need to run it the way any other business should, that is, charging for my time that has been put aside (and not made available to others), often with preparation in advance and travel (being a mobile practitioner means I often pre-book venues by the hour, plan my route as a geographic loop. Even so, it feels uncomfortable to charge for short-notice cancellations. The bottom line, though, is that we have made an agreement that is explained at the beginning of the service and the client has consented to. I encourage clients to make a choice and not sign if they don’t agree. The terms of the contract are in writing (or should be). Although I’m lenient at times, I fully support practitioners who consistently apply their cancellation/no-show policy.

  • Keith Z

    June 21st, 2021 at 2:45 PM

    Boo Hoo Hoo. You lose out on making $200-$300 for hour of talking
    I’ve never heard any therapist say anything so earth shattering that it’s worth that much even if they had 10 degrees
    It’s Scam and you are crying because you missed out on scamming someone

  • Rale

    July 14th, 2021 at 7:17 AM

    I wonder, if you are so strict for clients imperfections, how do you threat yours? For example, do you offer money back if yraou fail to deliver? Or therapy exists so you could have nice cozy source of huge income and if clients don’t get better, that is their fault? What if you come late or cancel last minute or you come late “just” 20-30 minutes or even 1 hour? You value your time very much, but as most therapists, it seams you value clients’ time much, much less, if anything at all, “clients are very useful trash, but that doesn’t make them less trash”. And probably, you don’t value clients at all, you just pretending. Which brings us to very basics of psychotherapy, especially those with “unconditional positive regard” and craps like that: therapy is bad acting and emotional prostitution. In most more serious cases therapy can’t make any substantial improvement and yet, just being money-hungry, therapists don’t admit that and accordingly lower fee. At least some therapists are well aware, but don’t have courage to talk about that: in pay for results model, say, 30 sessions for first goal, plus additional 10 as slack, and if you don’t deliver result after 40 sessions client leaves and pay nothing. Why clients should pay? Your time and “validation”? That makes you paid companion. Your expertise? You showed none. You have to rent office, pay bills etc? Nice, than be more effective therapist or make much lower fee. Giving close to year average salary for nothing isn’t model of good business practice anywhere, but psychotherapy. Imagine paying huge money for redecoration of your house and in best case you find new welcome sign in front of your doors. You would be furious and yet, you do exactly the same. And peoples’ health and lives are should be somewhat more important than redecoration.

  • Shane

    December 6th, 2021 at 11:32 AM

    “…and I came to recognize that the potential for frustration and resentment was not healthy for the therapeutic relationship.”
    I’m sure it does, but you must understand it works against the client as well and probably even more so. Your process is probably fair but for ongoing clients I think its worth it to have spend a few minutes talking this over and making sure they are completely understanding and on board before it happens. Not just having them sign a paper at on-boarding.

  • jen

    February 8th, 2022 at 1:00 PM

    I struggle with this as a therapist. I do let cancellations go occasionally, but it can lead to serious problems for me. I have to pay rent, supervision, professional membership fees and for training to keep my practice going. I can’t fill a timeslot with less than 48 hours notice, and I can’t always offer an alternative if there are no free slots left. Sometimes someone asks to reschedule in plenty of time, and I decline (not charging them of course) only to have someone else cancel late (too late to give to someone else who wants it and would pay). I can’t not pay for my other expenses and I can’t afford to work for free (I do give some pro-bono and discounted slots- but fix the number to protect my income). I recently had a client who also is self-employed who used sessions to work out whether or not he should charge for missed appointments- he decided he should- then cancelled 10 minutes before the start of our next appointment and never paid me!!! I don’t get too many missed appointments and in the main, it is possible to reschedule, but not always. I make my policy clear and it forms part of my contract with clients, so feel it is right to follow that – using discretion where I can, but not feeling guilty if I can’t. I find the run up to Christmas is the worst. I f I waived the Christmas week cancellations, I would be in the red for that week…

  • Jill

    September 8th, 2022 at 6:24 AM

    I briefly saw a therapist that has a 3-day cancellation policy. I had emailed her (which she had received) and told her I would be in contact regards our appointments. It was new I was not keen to continue, but my partner said I was to think about it. Then she sent a mail the following week for our appointment (which was not set up), and I just paid her the full fee, but I don’t want to see her again. Particularly that she did not respond at all after I sent the payment. Three days is too long. How do I know three days before something happens, it’s like a bit of a set-up to me.

  • Megan

    September 19th, 2022 at 2:09 PM

    Agree! Three days is way too much in my opinion. I wouldn’t do more than 24 hours!

  • Deb IMFT

    November 1st, 2022 at 1:59 PM

    It’s in my practice policies that less than 24 hrs notice MAY have a late fee charged up to the full amount of the session. I have never charged the full amount. I typically do not charge if its the first session a client has missed. And I explain that next time there may be a charge. If someone has a good reason for missing like illness, or other reasonable things, I do take that into consideration. I also offer a virtual appt. Instead if that helps my client. I know things happen out of our control. But if a client leaves a message 20 min before the appt and has not reason, or says something came up, I may go ahead and charge. And yes, I do track and often see a pattern with the same clients. It’s a common courtesy to let me know ahead of time, so that spot can be filled for someone else.

  • Mary

    February 8th, 2023 at 8:16 PM

    I have never been told of any such policy and my stylists doesn’t send any type of reminders. Each Monday I check my calendar and I’ll confirm with her this has been the same since day one. This particle Monday I was so sick o couldn’t lift my heat to check my phone, foils out later I have COVID she says I owe her $50 for late cancellation. Feeling very salty about this, as she’s cancelled last minute in me for he child many times. Not sure I’ll go back only because as a licensed professional and value my time I always send my clients reminders. Anyone expecting a fee as a professional should conduct their business as such and send out Text reminders. Not even gonna mention I have COVID this was beyond my control I was not well at all.

  • Lorelei

    March 14th, 2023 at 12:24 PM

    I all the comments i read, I see counselours charging a reduced fee or a full fee but I had never come across with a therapy office that charges 25 % on the top of the full fee, that’s 125% for a service not received. I think charging a full fee would be fair, since the therapist set time apart for the therapy, but 125 % I think is just an abusive practice. It gives me an uneasy feeling specially since it was the first time my daughther missed an appointment (actually she was just late) I feel hopeless and angry.

  • Megan MacCutcheon, LPC, PMH-C

    March 20th, 2023 at 7:58 PM

    Oh my goodness, Lorelei – I agree – Charging OVER the full fee makes no sense & seems very unfair. I would have a hard time feeling safe with a clinician who had a policy like this.

    I think it comes down to having mutual respect and it isn’t great for either party to take advantage of the other.
    Since the writing of this article, my practice and the demand for services has significantly increased. I now charge full fee (vs. 50% of the session fee) for late cancels and no-shows, but it’s very rare that I need to do so, as my clients are generally very good about emailing me the night before if they think they cannot make it.

    With the use of telehealth post the pandemic, I’m now able to offer virtual sessions and that has also helped eliminate the need to charge for late cancels. Many times clients, even when sick, will opt for a phone session from bed rather than cancel altogether. I will offer to have a brief “check-in” versus cancelling – – and often they wind up using the full session time and glad they didn’t skip after all. Many of my clients are moms – – so the option to do virtual vs. cancel due to sick kids at home has been great, too.

    So that is one thought I offer to colleagues – If your client cannot make it, can you do at least part of the session via phone if you will be charging either way?

    If they are late, have you checked in to see if they are on the way? Curious what people’s policies are regarding how long you wait before considering it a no-show.

    Another thing I want to add is that I hold myself to the same policies I enforce with my clients. There have been a few times where I messed up – Accidentally double booked two clients or had a scheduling error when a client showed up and I wasn’t there. In those instances, I did not charge the client for their next session. I feel much better about enforcing my policies when I respect my client’s time in return. There a difference between holding boundaries & respect and taking advantage of!

  • Janelle

    March 21st, 2023 at 5:12 PM

    What’s your policy for compensating your clients if YOU have to miss or reschedule an appointment with less than 24 hours notice? If you are going to hold them to a standard, shouldn’t you be holding yourself to at least that same standard? Not doing so sends a message that your time is far more valuable than theirs. Is that the message you want to be portraying to your clients?
    My husband and I both see a therapist (different therapists, same office). He has a standing appointment weekly. He found out the afternoon before his appointment, that he had to be into work early the next day. He emailed his therapist as soon as he found out, roughly 18 hours before the appointment. She charged him $100 for not providing 24 hours notice. We normally pay $25. Two weeks prior to this my husband was on his way to his appointment when he got a call from his therapist that she could not make it as she was having car troubles. He was over half way into the 30 minute drive across town. There was no compensation for his time lot or his travel expenses. Last week, I showed up to my 4pm appointment to find no therapist. I waited 10 minutes before calling, first my therapist, than the main office, I ended up leaving a message, I was in the office for over 25 minutes. It had been a 20 minute drive there, and a 20 minute drive back. I had to take off work to make this appointment. I was not compensated for my time or my travel expenses. While I fully understand the reason behind a policy, you need to also evaluate the other side of the situation. If you value your time enough to charge people for wasting it, shouldn’t you also value other peoples time enough to pay them for wasting it?

  • Yasmin

    March 23rd, 2023 at 3:17 AM

    I find it shocking that clients (I”ve been on both sides of this coin as a coach and client) balk at a cancellation fee. It’s ridiculous to say that a practitioner doesn’t lose money with a last minute reschedule. Let’s say the client schedules weekly at $225 per week and cancels short notice. There is no room to reschedule them before their appointment next week because of either their or the therapists schedule. That means they lose $225. Cancellation policies are not a punishment- they are simply a business agreement. No business can sustain themselves allowing these kinds of losses. Boundary setting/modeling is also best set in the beginning. I used to give clients a full hour when they were late but that just encourages lateness. I find that if the session is a priority, people don’t miss. In the years I’ve received therapy, I have canceled late once when I woke up at 3am with a 103.6 fever and couldn’t sit up for more than 15 minutes. My therapist didn’t charge me- it was early covid. Her policy and every other therapist’s policy has been full fee for anything less than 24 hours cancellation. As a coach (and before that healthcare professional/sales person), I know how disruptive cancelations are. Aside from my own time and loss of income, there is the rental space I use and the appointments I didn’t schedule for myself because I committed the time to the client. I’ve seen other coaches and therapists have a “no exception” policy, meaning if you cancel for any reason within 24 hours, you are charged for the session. I’m ok with that and have adopted that. I didn’t have a cancellation policy before and what did I get?- a last minute cancellation with no offer for compensation and several last minute schedule change requests. I’m moving towards a monthly pay in advance structure to hold the time with a forfeiture of sessions if not rescheduled in a certain time frame. Less drama and less potential resentment.

  • Megan MacCutcheon, LPC

    March 23rd, 2023 at 9:24 AM

    Agree that mutual respect for one another’s time is so important. I do hold myself to the same policies I enforce with my clients. There have been a few times where I messed up – Accidentally double booked two clients or had a scheduling error when a client showed up and I wasn’t there. In those instances, I did not charge the client for their next session. I had a client resist, saying it was no problem and I didn’t need to give a free session. But she’d come all the way to my office & I did feel terrible for making a mistake & wasting her time, so not charging at the next session felt right to me. I really hate charging for late cancels, but holding myself to the same standards makes it easier to enforce the policies.

  • Yasmin

    March 23rd, 2023 at 2:56 PM

    What you did was responsible and gracious. It’s a great example of a rupture and repair. I remember scheduling an appointment with a practitioner who made a mistake when I lived in Philadelphia. I was local but street parking requires a big time allotment as well as I tend to be early so I’m not late. She didn’t offer even a reduction on the reschedule so I didn’t reschedule. An apology without action is hollow. You are modeling accountability to your clients as well as integrity, which in itself is therapy. I have to remember that too- not enforcing stated boundaries harms the client.

  • Heath

    November 9th, 2023 at 10:50 PM

    I often hear people voice the opinion that therapists, of whatever profession within the mental health arena, do not really care for their clients; they are only in it for the $$. And yet an incident with my own therapist gave me a real-life experience to know that this is not always true or necessarily so.
    Having missed an appointment late one afternoon (there was a lot going on in my life at the time, of which she was aware), she phoned to see that I was OK and she even waive the ‘No-show’ fee as she appreciated why I had simply overlooked the appointment.
    This experience validated me as a person who was cared for and treated as an individual. And her not taking the ‘No-show’ fee that I had naturally offered, and expected, to pay, this showed me that therapists do care.
    People who suffer from a need that requires more professional interventions need to feel worthy. This is more so if they are finding themselves in a dark place. My own trauma was caused by a loss to suicide and the attendant issues of Complicated Grief and PTSD that had arisen from finding the person – a partner who I had shared my life with for 30 years. Given where I am sometimes at emotionally and mentally, I never set out to forget any appointments. I believe that a therapist should employ discretion with the individual client and not simply follow a policy (though I do understand the need for a printed policy for all clients to be aware off prior to entering into a therapeutic relationship)

Leave a Comment

By commenting you acknowledge acceptance of GoodTherapy.org's Terms and Conditions of Use.


* Indicates required field.

GoodTherapy uses cookies to personalize content and ads to provide better services for our users and to analyze our traffic. By continuing to use this site you consent to our cookies.