Let’s talk about dealing with no shows! It’s not glamorous, but all of us deal with no shows in private practice. In this article, I help you get ahead of the game by covering a few key topics related to client cancellations:
Do you need to have a cancellation policy?
How much to charge for a missed session
How to implement a cancellation policy
To help you, I offer a psychotherapy cancellation policy template for you to use as a guide at the end of the article as well.
In this article, I refer to no shows and cancellations interchangeably, though they describe two separate client behaviors.
A cancellation refers to when a client contacts their therapist in advance to cancel their psychotherapy appointment – even if it’s on short notice. A no show refers to when the client doesn’t show for their psychotherapy appointment, without giving their therapist advance notice.
What is a cancellation policy?
Even though the two refer to different behaviors, most therapists address both no shows and cancellations in a single policy. I’ll show you what this looks like in a bit.
A cancellation policy allows a therapist to clearly set expectations for what might happen if a client doesn’t show to their psychotherapy appointment or cancels on short notice.
It’s important to have a cancellation policy in writing that clearly states the parameters of what you charge and under what circumstances you charge for a client canceling an appointment. If you don’t have such a written policy, then it’s not legal to charge your client for not showing. It has to be documented in a written contract signed by both you and your client.
Why have a cancellation policy?
A psychotherapy cancellation policy centers around two concepts: 1) your time is valuable, and 2) you are running a profitable business, which means you can’t simply hold someone’s slot for free if someone else who was willing to show up and pay for their appointment could have used that time slot. Having a no-show policy ensures that clients take the process of therapy seriously rather than waste your time.
Without a cancellation policy in place, your psychotherapy clients would likely not show or cancel quite often.
How much do you charge for a missed psychotherapy session?
Each therapist develops their own strategy for this. If the client is paying out of pocket, therapists might still charge the full rate of the session or have a named dollar amount that is less than the full rate.
If clients typically apply insurance to pay for therapy, you’ll need to check on what rules each insurance panel has for such a scenario. Often insurance will not reimburse for a no-show, in which case it could be an option to charge the client your full rate out of pocket rather than simply paying their co-pay. Be sure to check with your state laws as well as all relevant insurance contracts to ensure you’re following appropriate protocol.
The amount you choose to charge is up to you. A strategy I use to help me decide is to ask: how much do I need to charge in order to not feel bitter after a client misses three sessions in a row? For me, this means charging my full rate. By following this strategy, we’re not harboring any hard feelings towards our clients when they do show up for an appointment.
Of course, it goes without saying that harboring bitter feelings towards our clients will likely disrupt the therapeutic process (but I just said it anyway ☺️)
Are there exceptions to a cancellation policy?
Many therapists waive the fee for the first time a client no-shows or cancels on short notice. This offers a nice opportunity to reiterate the policy so clients are fully aware the next time it happens. I tend to follow this practice, but the decision to do that is up to you.
It’s also worth naming for yourself what other exceptions you’ll follow for your cancellation policy. For example, if one of my clients is in a car accident, is sick, or has a close family member who is sick, then I waive the charge for an appointment canceled on short notice.
I do expect even in these scenarios that clients contact me rather than completely not showing altogether. But I use my judgment. For example, if a client has been sick with the flu for days and simply didn’t show to their appointment without letting me know, I still charge them for the missed appointment. If a client got into a car accident on the way to their appointment and they were unable to contact me to let me know, I definitely don’t charge.
Aside from these kinds of exceptions, most no shows and short notice cancellations occur because a client either forgot their appointment or they overbooked their schedule. In these cases, I always still charge for the missed session.
Be sure to know what your exceptions are before you start implementing a no show policy. It will help you feel much more confident approaching the topic with your clients.
How to implement a cancellation policy
This seems to be the big question! I know so many therapists who have no problems stating that they have a cancellation policy, but when it comes time to implement it they might shy away and simply not bring it up or choose to waive the fee.
If you implement a cancellation policy, be sure to follow these tips in order to implement it well:
1. Include it in your informed consent
Be sure to name under what circumstances you charge, how much you charge, and how you will charge the client. For example, my policy is a 24-hour cancellation policy, I charge the rate the client would otherwise pay for the session, and I charge them by sending them an invoice via Square.
2. Repeat it in the first session
Let’s be honest: most clients don’t read the initial paperwork. At the beginning of the first session, I describe my cancellation policy right after describing the limits of confidentiality.
3. Remind clients of your policy when they don’t show or cancel
I usually say something along the lines of, “as a reminder, I do charge for sessions canceled within less than 24 hours, and will be sending you an invoice via email.”
4. Don’t apologize
This is HUGE! If you followed all the prior protocol, then the client knows they are fully responsible for informing you in advance if they need to cancel. The cancellation fee is an opportunity for clients to develop a sense of responsibility. Or if they’re not really serious about counseling, it creates an opportunity for clients to consider whether they’re fully bought-in.
5. Circle back in the following session
Make sure to invite clients to share any questions or concerns about your policy during the next session that you meet. From my experience, the average client is completely understanding of the cancellation policy and can own whatever caused them to miss the appointment. However, from time to time clients may have a therapeutically relevant response towards you, and it’s important to address how they feel about what happened.
6. If it keeps happening: dive deeper
From my experience, everyone has a hiccup from time to time and misses an appointment. But some clients will miss sessions fairly regularly. When this happens, it may be a good time to check in about the therapeutic implications: How do they feel therapy is going? How bought-in to the process are they? Are there any changes that would be helpful to their growth and success?
Psychotherapy Cancellation Policy Template
I hope you found these tips helpful in implementing a cancellation policy. You’re free to word your policy in whatever way you wish, but if you would like to have an example to work from, here is a free psychotherapy cancellation policy template for you to use:
Cancellations: Since the scheduling of an appointment involves the reservation of time set aside especially for you, a minimum of 24 hours notice is required for rescheduling or cancellation of an appointment. If for any reason a session is canceled less than 24 hours prior, the full fee will be charged. You may also inquire whether there is an option to meet virtually if you’re unable to attand an in-person session. Please note that most insurance does not reimburse for missed sessions.
I put the policy directly in my informed consent and use headers to clearly mark the policy.
If you already have a cancellation policy in place but your clients have a high no show rate, you might like to check out my video: How to Reduce No Shows in Private Practice
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I hope your cancellation policy helps reduce psychotherapy cancellations in your practice. And until next time, from one therapist to another: I wish you well!