No Shows and Late Cancellations

Many new therapists aren’t sure how to handle client no-shows and late cancellations.  I’ve looked at informed consent documents with very ambiguous policies or no policy at all.  Even once therapists have a clear policy in place, they may have belief systems about money or themselves that make it difficult for them to stay consistent in enforcing the policy.

We live in a culture where talking about money is mostly taboo.  Remaining silent about money obscures our clarity about who we are in relationship to money, and what we consider appropriate and possible.  In the absence of open conversations about money, some of us decide that money is inherently wrong, incompatible with helping, or unimportant.  Others decide that they don’t deserve money, or that earning money would represent a kind of family betrayal.

Early on in my own practice, I was afraid that clients would get upset about my charging them for missed appointments, even though they’d already agreed to it.  It took time for me to work through these fears and accept upset as a possibility.  Indeed, one of my clients ended therapy with me after I charged them for a missed appointment.   That can happen.

Here’s my current policy, which I review and agree to with clients at the start of therapy:

  • I charge $50 for appointments that clients miss without giving 48 hours’ notice. Some therapists charge the full fee for appointments missed without adequate notice.  For the amount of notice, choose an amount of time that would still allow you to schedule with another client during the newly available time.
  • Similarly, if I were to cancel with a client on short notice, I would credit them $50 towards their next visit. I hold myself to the same level of responsibility regarding scheduling that I ask of my clients.
  • If a client hasn’t arrived nor contacted me fifteen minutes after our scheduled start time, I assume they won’t be attending and charge them $50. If they contact me before then to let me know they’ll be arriving late, we use whatever remaining time we have for a session.
  • I generally don’t make exceptions (i.e. waive the no-show or late cancellation fee) for client emergencies. It’s a reasonable enough thing to do, but I prefer not to haggle over what constitutes an emergency, nor absorb the financial impact of clients’ personal circumstances.
  • If either the client or I expect that traveling to or from the appointment will be unsafe due to weather, I don’t charge or credit them for our rescheduling or canceling within 48 hours.

If a client doesn’t show for their appointment, I’ll never just fire off an invoice.  I’ll always call about ten minutes after our scheduled start time, and say something like:

Hey Joe, it’s Ryan.  I had us down for 11:30 this morning and just wanted to call to see if we were on the same page.  Give me a call if you’re on your way or so that we can reschedule.

Once I hear back from them, so long as there was no miscommunication about the scheduled time (and since most of my clients self-schedule online, there rarely is), I ask for payment for the missed session.

Let’s also go over some other, special circumstances:

  • Some therapists choose to waive the no-show or late cancellation fee if they’re able to fit the client into another available time they have that same day or week. I’ve steered clear of this.
  • I don’t charge clients for missing an initial consultation without giving adequate notice, because my consultations are free. I do charge for no-showing or late canceling a first appointment if we’d already reviewed and agreed to my policies beforehand, during the initial consultation.  Some clients remain undecided about beginning together after the initial consultation, so we don’t go over my policies until the first session; in these cases, I wouldn’t charge for missing the first appointment without adequate notice.
  • I work with several pro-bono clients, and will not charge them for appointments they miss without adequate notice. But I do speak with them about the impact that has on me, and that’s usually enough for it to become a non-issue.

If a client is no-showing or late canceling excessively, I talk with them about it.  We try to learn more about why it’s happening, and if it’s emblematic of their current life circumstances or relationship to therapy.  The client may be overcommitted, resistant to the change process, feeling dissatisfied with the therapeutic relationship, or any number of other things.

If they do want to continue the work with better consistency, we brainstorm ways to make that happen.  I certainly don’t want clients to continue paying for missed time.   I’ve found that offering automated appointment reminders, a feature of most online practice management systems, has mostly eliminated no-shows.  Sometimes we do decide that it’s not the right time for them to be pursuing the work, or not the right therapeutic relationship, and so we agree to pause or complete.

Take some time to reflect on the early messages you received or did not receive about money.  Were these restrictive or empowering?  Begin to develop a policy that’s truly your own, and that really works for you.