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When The Therapist No Shows

Last week’s post How To Get Paid For No Shows prompted some excellent discussions and follow up questions about how to enforce cancellation and payment policies. One comment in particular, posted by “Paul” brought up a valid concern.

Do your policies go both ways? How do you handle the situation when you, the therapist, no show for a session due to a scheduling error, inadvertently double book a session, or cancel a session at the last minute due to illness? Here’s what he wrote:

What happens if the therapist needs to cancel a therapy session with less than 24 hours notice to the client?

This isn’t a sarcastic question. My dentist has a policy similar to yours and I don’t really have a problem with it in general. However, one day I needed to rearrange my work schedule to accommodate an appointment with the dentist. The morning of the appointment I received a call stating that the dentist was sick and wouldn’t be available for my appointment. Ok, no problem, these things happen. They were able to reschedule me quickly, too.

A few months later the reverse happened – I had something very important and completely unavoidable come up and I had to cancel the morning of a scheduled afternoon appointment. To their credit, they acknowledged that I’ve been a client for several years and had never missed an appointment or had to cancel without 24 hours notice prior to this incident. They didn’t charge me and all was good.

What’s annoying is that not all offices practice this. Some are all too willing to charge a client who no-shows or calls to cancel with less than 24 hours notice, but when they need to cancel with less than 24 hours notice they act as if it’s no big deal and the client is expected to simply shrug it off.

If we, as therapists, expect clients to follow through with their session or pay for the missed session, shouldn’t we offer them the same courtesy and model the accountability that we are requiring of them?

When the therapist no-shows

If I miss an appointment due to a scheduling error on my end, I offer the client a free session. If I am running more than 15 minutes late to a session I generally offer the session for free as well.

When the client or therapist is sick

To clarify, I don’t charge for no-shows when there is an illness or an emergency on the client’s end. If I am ill I don’t offer a free session unless I was unable to reach the client and then showed up for the scheduled appointment. However, I do watch closely for patterns in client behavior. If they are sick every other week, then I treat it as a relationship pattern and deal with it as a clinical issue in therapy sessions.

How do you handle the situation when you, the therapist, no show, double book, or have to cancel at the last minute due to illness or accident?


About Dr. Julie Hanks, LCSW:
Dynamic self & relationship expert Dr. Julie de Azevedo Hanks, LCSW loves to make a difference for women. She owns Wasatch Family Therapy and regularly contributes to TV Shows and her advice has been featured nationally including Wall Street Journal, Parenting, Fox News, and others. Connect on Instagram, Facebook & Twitter. Her books The Burnout Cure and The Assertiveness Guide are now available. Dr. Hanks is currently accepting coaching clients.



Thank you for this post. Finally someone started talking about mutual commitment and accountability, therapist’s and client’s alike. It was always mind-boggling to me, both as a client and as a professional, how come a cancellation and no-show policy doesn’t work both ways not only in psychotherapy practice but in medical practice in general. Didn’t seem fair..

Since I ask 50% of the session for missed or less-than-24-hours cancellations, I consider honest to offer the same when I mixed up something in the appointment… for example, a month ago, I forgot to write an appointment I gave to a client in my agenda. 2 patients then came at the same time…..

I had to decide wich one I would see and offer the next session at 50% for the one I couln’t see.

Stephanie Morgan, MFT

I charge clients for all planned sessions whether they use them or not. I offer 2 weeks of pre-planned “vacation” per year where clients don’t need to reschedule or pay for those missed sessions. I also offer to reschedule missed appointments with “day before” notice. same day cancellations are always charged in full.
On the verrrry rare occasion that I cancel same day due to illness or accident, I offer my clients another “vacation day” to be used later than year.
This has worked really well both for my business, for the clinical work, and for the relationships I have with my clients.
I have a full, private pay practice in the San Francisco Bay Area.

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