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Late Cancellations and No-Shows – What to Do When Clients Don’t Turn Up to Therapy

Working as a therapist in private practice is incredibly rewarding, but it’s not without its challenges. We’re often working with people at a difficult time in their lives. Things may be chaotic and stressful for them, so it’s not uncommon for someone to occasionally get the time or day of their appointment wrong. Some even forget completely. Although it’s completely understandable, this can have a negative impact on your business so it’s important you have processes in place to deal with late cancellations and no-shows when they arise.

What’s Your Cancellation Policy?

I think a late cancellation or no-show policy should be one that if it were imposed on you, you would be happy with it. I recently missed an appointment at my dentist for the first time ever. It was a genuine error and I was completely mortified, so I really appreciated their compassionate response.

What feels fair will vary from one individual to the next. You can’t make everyone happy, so you need to do what’s right for you. After all, your business should be a lovely place to work. It needs to feel secure, boundaried and fair.

Personally, I require 24 hours’ notice to cancel a therapy session without incurring a charge. If a client’s appointment is on a Monday, they must cancel no later than the Friday before. If less than 24 hours’ notice is provided, I reserve the right to charge half the cost of their session to cover incurred costs. If they fail to attend a session without any notice, full payment for that session will be required before booking any further sessions, and their file will be placed on hold.

How to Communicate and Enforce Your Policy

As with most boundaries, you need to be clear about your cancellation policy and repeat it multiple times. I communicate my policy on my website, in therapy agreements, in the email confirming appointments and during a client’s first session. Despite this, people can still be unaware.

If someone doesn’t show up for their first therapy session, I discharge them. I don’t give this any energy at all. If an existing client misses an appointment, I send a quick email to check they’re ok and keep the lines of communication open. I also use this as an opportunity to repeat my cancellation policy and explain they’ll be charged if it happens again.

Text and email reminders have been a game-changer for me. They’ve greatly reduced the likelihood someone will forget their appointment. We all have busy lives and people seem to really appreciate receiving a gentle nudge to help them remember.

The Financial Impact

In the first few years of running a private practice, things can be pretty tight financially. When you’re building a caseload, late cancellations and no-shows can really affect your profit and income. The best thing to do is accept it will happen and plan plan plan!

My pricing accounts for the fact most people will fail to attend at least one session or have to cancel late during the course of therapy. I also overbook my clinics by one to two clients a week to cover the costs of cancellations or appointments being rearranged.

Some therapists have a pre-pay system which means clients pay for their session when they book. Although it makes perfect sense from a business point of view, this doesn’t sit well with me. If I had to pay for my hair appointment upon booking, it would feel like too much commitment. I really don’t want someone to come to a therapy session just because they’ve paid and can’t get out of it. I’d rather have the no-show.

When Things Get Messy

Don’t panic. Start from the position of trusting the person and being respectful of what is happening for them. If a client fails to attend an appointment or cancels late, you can send an invoice for the session. If it’s the first time this has happened, I use it as an opportunity to remind the person of my policies. On the second occasion, I would email an invoice straight over.

During the many years I’ve been in private practice I’ve only had to chase this payment once. I sent the individual a final notice letter following guidance published on the GOV.UK website and the invoice was quickly paid. I also know therapists who have had success taking unpaid invoices to the small claims court. You can find all the information you need here.

The first couple of times you experience a late cancellation or no-show, talk it through with your supervisor. Are you annoyed or irritated? Are you worried about the lack of income or a dwindling caseload? Recognise these are your own feelings and don’t let them enter into your dialogue with the client.

You can also reframe the situation and see it as an opportunity to review and improve your policies and processes. It can be tempting to put harsh or overly strict rules in place after a bad experience, but you shouldn’t let one person shape your business. Remember your core values and act accordingly. With experience, no-shows will have very little impact, I promise.

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Comments

  1. Sarah Cosway says

    A really helpful article – thank you! Reading through this has helped me reflect on my own approach and given me more confidence – previously I haven’t been boundaried enough about late cancellations.

  2. Sarah Rees says

    Thanks, Sarah, glad you found it helpful I’m still a work in progress with it.

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Sarah Rees

Sarah is a fully accredited Cognitive Behavioural Therapist and mental health writer delivering Modern Mental Health for you and with you in Mind. Sarah is the author of ‘The CBT Journal’ which helps you write for your wellbeing incorporating CBT techniques. For more information and to keep in touch have a look at sarahdrees.co.uk.