Trauma-Informed Therapist | Clinical Supervisor | Group Private Practice Owner | Counselor Educator | Consultant, Trainer & Advocate for Culturally Responsive Mental Health Practices
Question for all my fellow #therapists: At some stage in a private practice therapist's career, it's typical to face challenges when enforcing their cancellation policy for clients who don't show up or cancel within 24 or 48 hours. This policy often involves charging clients 50% to 100% of the service fee (which varies based on the setting and clinician) to compensate for the time the clinician has set aside and the difficulty in scheduling someone new on short notice, resulting in a lost hour. Despite the policy's validity and its respect for the therapist's time, what makes it so challenging to enforce? What has helped you overcome the discomfort of enforcing this policy if you're no longer feeling anxious about it? #privatepractice #mentalhealtheducation #mentalhealth #clinicalsupervision
Like Jillian Knight, LMFT mentioned, I think it’s one of the many issues therapists have with money! I think many feel excessive guilt about it for various reasons. I honestly have a pretty flexible policy, and I think bc of that, it’s easier to enforce when I truly need to. I charge a flat cancellation fee of $50, which hurts just enough to be motivating without feeling really painful like a full session. I also give everyone a first time freebie. So when I charge, I know I’ve been more than reasonable already. My policy might be too flexible for some therapists, but it works for me 🤷🏻♀️ I also went through some emergency medical issues a few years ago where I was hospitalized 3 times in 3 months, and had to cancel A LOT. My clients were flexible and gracious toward me, so that has informed my policy.
Vasundhara Gupta
9mo
I’m extremely new to private practice (6 months) and have struggled with the discomfort that comes along with enforcing a similar policy! I usually allow for one free cancellation/reschecule and take that as an opportunity to reiterate my policy. I have also found coming from a place of empathy and curiosity, wherein I’ve shown genuine concern about a cancellation ALONGSIDE staying true to my policies has allowed me to deal with that discomfort well without it affecting my practice.
Mine was multilayered, and ultimately not having a firm business mindset in the beginning set my trajectory on cascade down a mountain I could not stop leading to business demise. I must say this is in no way to over generalize the population, but reading and listening to peers its easy to assess a lot of clinicians do not have a business background for one, we are empaths who "understand". We are selfless to the point of over-extension. And even though we teach boundaries we do not enforce our own to give "opportunity" to build discrepancy of how their no shown impacts the bottom line. My journey began pre covid, Jan 1 2020 and unexpectedly escalated during shut down. I at the time did not have business savvy then as the world was in crisis and I was putting out emotional fires. Not to mention, many individuals were waiting on unemployment after being fired. They were now on fixed income. So, enforcing a no show fee/late cancelation fee seemed "inhumane" and unreasonable. People dodged me like a plague for their outstanding bills after acquiring the skills needed to manage, and well... shame on me... it cost me something I enjoyed doing. BUT! Recognize that this experience was a lesson I take forward of assertion.
Dr. Judy Guess
9mo
An early on bad experience makes me hesitate to charge any cancellation fee. I am in a small community where word travels fast and I had someone blast me all over social media because I had "no compassion" and "should not be in the helping profession" - not that I charged the agreed upon fee when they no-showed the second time. Now, I don't charge a fee, but I also don't let no-shows accumulate or let payments add up. In my situation, I feel like I have a much better handle on it 12 years in than I did those first couple years. Everyone gets 1 no-show/late cancel a year. On the 2nd one, they can't reschedule for 3 months and on the 3rd, it's 6 months. That's my policy. Honestly, I'm just way more picky at the onset before agreeing to work with an individual client. It hasn't been an issue in literally years.
Earlier in my career I was worried clients would get upset with me for charging the fee. Doing my own work around people pleasing, boundaries and money work helped with that. There are MANY layers to the issues therapists tend to have around money. This is just one example of how it shows up.
I remind myself that every part of the therapy experience (policies, correspondence, cleanliness of the office, etc etc etc) has therapeutic intention & the capacity to either enhance or hinder the treatment. How I uphold policies has the ability to provide structure, reliability, predictability, boundaries, and trust for a client who may otherwise not be used to such elements in a relationship. It is modeling. It provides an opportunity for constructive communication if the client is upset, or it provides and opportunity for the client to practice self-advocacy if needed. Something I tell my clients is that every piece of the therapy experience has the capacity to be therapeutic. One of the ways I have overcome challenges with this is, as many other commenters mentioned, my own work around money mindset. But also a reminder that I am a service provider & I can only provide a service that is as healthy as I am, and having my financial needs met allows me to do so. My fee is the full session fee with less than 24 hour notice. However I make room for flexibility regarding illness or emergencies, and I waive the fee if the client reschedules the appointment prior to their next appointment. Great conversation!
I find that when therapists are only being paid for their attended sessions and that’s it, there’s a lot of potential for resentment towards clients or financial stress as there’s no fixed salary or amount of money to depend on each month. It’s usually variable.
It’s a commitment I made to myself when I started. I value my time enough to charge the fee and ensure it is paid before scheduling further. I am extremely up front about this in the intske appointment.
Be very firm about your policies, and get a valid credit card from them checking the expiration date. Charge a “rescheduling fee” which sounds better and get 80-100% of the hourly fee. The point is to diminish the behavior which may be part of the reason that they are seeing you.
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9moI enforce it by seeing myself as no different than any other professional service provider, as I have to value my time because no one else will value it for me. Also, there is a reciprocal relationship when I charge the fee: I rarely have to use it more than once, it recenters the professional nature of the relationship, and it puts the onus of work/change back on the client where it belongs, as they have to take responsibility. As the great Carl Whitaker, MD stated: “[Therapists]have to win the battle for structure and lost it for initiative”.