Guidelines for Setting Your Therapist Cancellation Policy

Here you are. You're facing another no-show. Or a client cancels at the very last minute. You have something about this in your informed consent process, but enforcing the late cancellation fee feels...mean? Unfair? Awkward?

Most therapists have excellent intentions when they open their counseling practice. They want to help people and make the world a better place. But, at the same time, they don't want to be chasing a full-session fee and risk rupturing the therapeutic relationship.

And yet, it's a really good business practice to have a cancellation policy. It's even better when you implement it. Here are my best guidelines.

Understanding What a Cancellation Policy Really Means

Your cancellation policy refers to how you address missed sessions or late cancellations in your private practice. It's a set of guidelines that help both you and your client to know what to expect.

A cancellation policy doesn't automatically mean you charge a full fee (this is a misconception that many therapists seem to have). But it does mean that you have something in writing about addressing a cancelled appointment.

Why A Cancellation Policy Matters So Much

Is your income all over the place? Do you feel like you're working all the time- only to realize that your therapy practice is full of cancellations and no-shows?

I'm telling you this: you lose money without a cancellation policy, and your cancellation fee helps both you and your clients.

As a private practice therapist, every time slot is reserved for generating income. Unfortunately, this is the part of the business that makes some clinicians squirm. They don't want to be perceived as money-driven; they don't want people who seek services thinking they only care about the session fee.

And yet, your time is so valuable, isn't it? How are you supposed to make a living if you don't honor the work dedicated for each time slot? You can be a completely understanding therapist- the most empathic human in the world- but if you don't generate enough income, if you keep facing missed appointments after missed appointments, your practice will suffer.

Not only do you lose income by no-shows or late cancellations, but you also sometimes pay for losing money. What do I mean by that? Well, figure out the cost of gas, office rent, and other miscellaneous fees that go into a session. Then, compute the cost of turning down potential clients because you don't have room on your caseload. Suddenly, missed appointments feel a lot more costly.

Here's another thing: if you have a cancellation policy, but you don't enforce it, what kind of boundary does that model for your clients? What do clients hear when you say one thing but do another? What does it mean when you have an informed consent form that clearly outlines your policy- only for you to make exceptions every time?

Common Cancellation Policies (And How Well They Work)

Having a cancellation policy in place is important. But how do you decide which policy to implement? And which cancellation fees should you impose? Here are some common strategies other therapists are using.

No-Cost Cancellation Policy

This is the least restrictive method, and some therapists stand by it. At the height of COVID, many people shifted toward this model. They didn’t want to punish people for being sick or needing to handle emergency childcare. 

Others have this policy as more of a passive approach. They don’t want to deal with the awkwardness, so they don't charge a cancellation fee if a client cancels. A client can provide 24 hours notice or 2 hours notice, but you don't charge.

Pros: You avoid awkward conversations about boundaries and payment. Your clients might "like" you more. Some think this sets a good standard for mental health and respecting a client's time and autonomy. You may mitigate the risk of catching a contagious illness as clients won't come in sick.

Cons: You risk clients taking advantage of your practice. If there are no penalties for cancelling therapy sessions, what stops someone from just reaching out a few minutes before? Why even give adequate notice if it isn't necessary? You risk growing resentful of certain clients. You may have hours of wasted time slots in your practice. You’re probably at the highest risk for 

24, 48, 72-hour Policy

This is a pretty common practice among therapists. Therapists give clients a range from 24 hours to 72 hours to cancel their therapy sessions without charge. The client, of course, is responsible for reaching out within that designated time frame.

Therapists will then charge a full fee for cancellations that occur outside of that window. Some will charge a specific cancellation fee that may be around 50-70% of the full fee. 

Pros: You will likely have significantly fewer missed sessions than if you had no cancellation policy in place. You recoup some of the costs associated with the inevitable no-shows. A client knows they can't just bail on their appointment anytime without consequences.

Cons: You must be willing to implement this policy. If you make exceptions, you need to really know why you're making those exceptions. You'll definitely face situations where clients cite a medical or clinical emergency that falls outside of the cancellation window, and you'll need to know how you intend to handle those. How you uphold (or don't uphold) such a policy can impact the therapeutic process.

No-Exceptions Cancellation Policy 

Some therapists have a no-exceptions cancellation policy. It’s about as straightforward as it gets. The client is charged a full (or partial fee) in the event of cancelling.

Some therapists will allow 1-2 freebies if this is the case. Others will waive the fee if the client reschedules for another appointment within a set timeframe. 

Pros: You’ll probably have the least amount of session cancellations with this policy. It’s very cut-and-dry, and it’s the best bet for generating consistent income. This policy can be ideal if you have a full caseload or a long waitlist. 

Cons: Some clients will find it harsh. They might forget and then become very angry if you enforce it after they cancel. You may feel guilty about implementing it when serious emergencies or extraneous variables arise. If you allow unlimited reschedules, your calendar may get confusing and chaotic. 

What If You Have to Miss a Session? 

Even though you’re a therapist, you’re also a human, and life is life.

I've had to reschedule sessions before! Most recently, my little one woke up sick, and I needed to cancel my appointments that day. So, I presented everyone with a "reschedule" option or a "freebie." The freebie meant they could cancel a therapy session in the future without penalty.

Why You Have to Be Explicit With Your Cancellation Policy

Many therapists just rush into the informed consent process during the first appointment. By the way, I have a 24-hour notice cancellation policy. If you don't cancel before that time frame, I will have to charge you the full fee. Now, let's talk about the limits of confidentiality...

This is a start, but if this is your only conversation about your cancellation policy or no-show fee, you can't possibly expect your clients to remember it. During that first session, they're already being bombarded with a ton of information about your practice.

And so, I really recommend spending a good deal of time outlining this policy. Many clients want to please their therapists.

Here is a script that drives the point home:

I want to spend a few minutes talking about my cancellation policy. I want to start by saying that I may get redundant at points, but that's only because I really want to make sure you understand how this process works. I don't want to risk any potential miscommunication.

I have a 48-hour cancellation policy in my practice. That means you can provide me with up to 48 hours notice without being charged. I understand that life happens- an emergency may occur. You could get sick. Your kids get sick. There are lots of reasons for a missed session.

And while I want to be mindful of these reasons, I dedicate your time reserved exclusively for you. It's similar to any other necessary medical appointment.

What About Client Pushback?

Most therapists fear that all their clients will hate and leave them once they start enforcing a cancellation policy. They worry they will lose clients and have their reputation sabotaged. 

I relate to this fear. I’ve had it myself. 

But here's what I’ve found. Most clients don’t have much of a reaction at all. If anything, they’re used to these types of policies with other healthcare providers. And if you outline this expectation from the start, it becomes an inherent part of the therapeutic process. There are no surprises. 

In addition, we have an exceptional job in being able to model healthy boundaries within our counseling practice. By staying consistent and professional in your work, you will find that most clients appreciate your set limits. They don’t have to guess your intentions or plans.

And so, you owe it to yourself and your business to honor the integrity of each therapy hour. A sequence of no-shows or late cancellations can compromise this flow. If it’s happening to you, it’s time to reflect and reassess.