Client cancellations and no-shows are very difficult for therapists. Clients can be so casual about cancelling that I sometimes wonder if they think we get paid by salary. In addition to cancellations being frustrating for therapists, they are also very bad for the client. Often when they come in the following week, the therapist finds that after missing their appointment, the client is now in crisis or has gotten worse. Really, it is best for the client to come in for their appointment every week until they have made enough progress that they can reduce sessions. Of course, no therapist would disagree with me that the best way for a client to make progress is to come to every appointment, but they often wonder how they can make that happen. Well, I’d like to give some advice on how to do that.
1. Give reminders: I have very few cancellations and no-shows are almost unheard of, and although I think that is due to a number of reasons, I think that one of the biggest reasons why is that I remind my clients of their appointments. I’ve never had a client use the excuse that they’ve “forgotten” about their appointment because their is just no way that could ever happen. At the end of each session, I always give the client an appointment card. Then I enter their appointment into a program called Appointy. Appointy then sends the client an email alerting them that an appointment has been made. Appointy then emails them another reminder 24 hours before their appointment. Now, I know that a lot of therapists don’t like giving client’s reminders, but just switching to this system cut down my cancellation rate by a whole lot.
2. Have deterrents: A good deterrent is to have it clearly stated in your office policies that if clients miss their appointment that they will have to pay some kind of fee. I also remind clients of this on my voicemail message. The idea of a deterrent is that it makes the client reluctant to cancel unless they absolutely have to. A lot of therapists see cancellation fees as a way to still get paid even if they don’t see the client. However, I think that the real value is in preventing that from happening in the first place. Of course, fees don’t work as deterrents if the client was unaware of them. You should make it very clear to the client that these fees exist and how they can avoid them. My personal policy is that I wont charge the fee so long as they can still reschedule within that same week.
3. Have behavioral consequences: Examples of behavioral consequences including enforcing your cancellation policy and even terminating with clients that cancel excessively. For a while, I would feel really bad about collecting my cancellation fee. My client seemed so sorry and always promised not to ever do it again. But she kept cancelling last minute. Finally I decided to enforce my fee. I told her that I would not be giving her another appointment until I collected my fee. She paid right away and never cancelled again. The point is, some people will never change unless there are consequences to their behaviors. Sometimes it might even be necessary to fire a client. It’s really better for the client to not be in your care if they are hardly ever seeing you. Also, being fired might motivate them to be more responsible with the next therapist.