Why a No-Show and Cancellation Policy Is Essential for Therapists

Wondering whether you need a no-show and cancellation policy with your therapy clients?

You’re not alone.

If I were to write an article titled “3 Things Therapists Don’t Like to Think About,” the list would include making an abuse report, needing to break client confidentiality, and charging your client’s credit card for a no-show or late cancellation on their scheduled appointment. 

These topic of a no-show and cancellation policy is uncomfortable to confront, however it inevitably comes up in the business of therapy.

Even when we have a well-communicated no-show and cancellation policy, it can feel wrong to charge clients when they fail to show up for their session or cancel without sufficient notice.

We’re supposed to be supportive and understanding, right?

Yes, we are. 

However, there is a line (though it may sometimes feel like a blurry line) between being an understanding therapist and modeling poor boundaries. 

I have struggled with the dichotomy of being a non-judgmental, compassionate presence for clients and then charging their credit card because they forgot to cancel their therapy appointment before leaving to travel out of town. 

3 Reasons why all therapists need a no-show and cancellation policy

Through trial and error, endless chats with my therapist best friend, and self-reflection, I have determined three key pillars that highlight and remind us of the importance of setting, communicating, and upholding a no-show and cancellation policy.

1. Your time is valuable

Time is a commodity, and our time is valuable. 

Receiving a text message from a client 30 minutes before their scheduled session asking to cancel the appointment may seem easy to accommodate, however it also means an hour that you were not able to see another client. 

Imagine if you canceled on one of your clients 30 minutes before their scheduled session. That would not be deemed acceptable or professional. 

I believe in holding my clients to the same standards that I hold myself when it comes to the professional aspect of our relationship. 

In creating and upholding a firm cancellation policy, I set the same expectations for them as I would for myself. 

Yes, surprises do come up. And when they do, as with most things in life, there are consequences.

Sometimes the things that come up are out of our control, but the consequences remain, nonetheless. 

This is certainly true outside of therapy. 

Our sessions and our relationships with clients do not exist in a place with different consequences or rules than the rest of the world. 

Practicing this and helping clients process the residual feelings around these consequences is actually helpful and not hurtful to our clients.

2. Business is business​​—even in private therapy practice

Have you ever booked a flight and then missed it because you were stuck in traffic? 

If so, did the airline refund you your ticket price?

Probably not. 

Similarly, as a clinician, your price for a no-show or late cancellation says, “This is the value of a 50-minute slot of my professional time. You booked one of these sessions, and, therefore, you owe me the cost of this time.” 

The things we know about a client’s hardships and stresses make this muddy.

It can feel unkind to charge someone that you know is going through a rough patch.

Interventions and treatment goals aside, therapy is our livelihood. 

We have a responsibility to ourselves and to the larger mental health community to place a reasonable price on our time and the work we do. This helps highlight the importance of our skillset.

Your cost per session is the value you place on your time, expertise, skills, and experience. 

We pay for license renewal, continued education, and office rent whether or not our clients show up.

I charge the full fee of that 50-minute slot if a client no-shows or “late cancels.”

Anything less than 24 hours notice I consider a late cancellation.

I want my clients to be successful in managing their time and responsibilities.

Setting up automatic appointment reminders is free and easy with SimplePractice, and it’s one tactic I use to support my clients in developing time management skills. Sign up for a free, 30-day trial of SimplePractice  to experience the benefits of online booking with automatic appointment reminders.

I send 48-hour advance email notifications and 24-hour advance text message appointment reminders for my sessions to help clients minimize instances of being charged for a missed session. 

If you struggle with seeing yourself simultaneously as a business person and a therapist, I recommend you check in with your fellow therapist colleagues. Spoiler alert: we all deal with this issue!

3. You model boundaries and integrity to your clients

Let’s take time and money out of the equation for a moment. 

Something that has helped me in addressing my own “late fee guilt” is the concept of integrity.

It is important for me that I model to clients my own boundaries. 

Charging for a late cancellation is not something I spring on clients in-the-moment. 

In fact, that would be unethical. 

I added my no-show and cancellation policy into the consent forms which I ask clients to sign before beginning services.

They agree to this fee before there is even a chance to no-show or text me with a late cancellation.

They have been informed in clear language ahead of time.

I believe that makes the charge for any violations of my no-show and cancellation policy fair and understandable.

The concept of boundaries is a conversation I have with all of my clients before beginning treatment.

In order to continue to do this work, I need to have professional boundaries.

Just as I would never accept a social media friend request from a client, I will not excuse a late cancellation or no-show without a fee. 

My cancellation policy is a prime opportunity for me to model how to set and hold boundaries.

Without question, this is a challenging aspect of our jobs. 

I encourage fellow therapists to think about personal values, responsibilities as a mental health care provider, and the culture of your private practice when determining how you want to navigate this.

Final words on creating and upholding a no-show and cancellation policy

Maybe you want to create a no-show and cancellation policy that contains a three-strike rule? Or, perhaps you charge half price for a cancellation?

Finally, perhaps there are specific reasons you choose to exercise discretion and offer exceptions to your standard policy.

If this is the case, you could consider creating and upholding a unique case-by-case plan with each individual client.

The beauty of private practice is that we get to create and establish our own policies that feel authentic to us.

Having difficult conversations helps our clients and, in turn, helps us. 

Our clients can practice voicing their feelings and advocating for themselves. And we can do the same. 

As therapists, we can empathize with the disappointment the client may experience when the cancellation or no-show fee is billed to their credit card. 

However, we do not need to feel bad about adhering to a policy we announced to our existing clients and mutually agreed upon at the beginning of our relationship with new clients.

We can talk about it with the client, process the feelings, and try to help minimize instances like this in the future.

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