No-Show, No Problem: How Therapists Prepare for Late Cancellations and No-Shows

Have you ever felt frustrated because a client canceled their appointment with little notice and you’re already in the office? 

How about just completely not showing up without a word?

While therapy seems to be progressing well for a client, they might suddenly become a little flaky. If they start to cancel last minute, continuously reschedule, or just plain not show up it can be understandably aggravating. 

Sometimes it can feel like you’re the cause of this and that maybe you were doing something wrong, or as if the clients are disrespecting you. 

We’re here to tell you that you’re not alone, and there are steps you can take to minimize the occurrence of these events and protect your time. 

Sometimes things come up and plans need to be changed. If systems are put into place to handle no-shows and late cancellations it can really take some of the headache away in dealing with these issues.

Why Do Clients Cancel Therapy Sessions?

If therapy was going so well, why would a client cancel a session? 

Emergencies happen, or the client may have simply forgotten about another event that was scheduled at the same time. Usually, they’ll have a valid reason for needing to reschedule or cancel sessions, and most of the time they are doing it with plenty of notice. 

Unfortunately, there are those that also purposefully don’t show up or continue to push appointments back at the last minute, which can be detrimental to themselves and you.

When clients start to no-show, or frequently cancel without notice, this becomes a real problem for your practice. If you haven’t already been enforcing a therapy no-show and late cancellation policy, we’ll go over how implementing this can save your business and sanity.

Therapy No-Show and Late Cancellation Policies

One of the most effective strategies in decreasing the occurrence of these last minute schedule changes is to create a policy that is actually enforced. 

When someone new comes in, it's important to communicate this with them so they know right away. 

Your time is money – especially as the owner of a private practice. If you continue to hold slots for clients that cancel, and do not take a fee from them, your income can be negatively impacted, especially if you had someone else that wanted to come at that time. When you create a no-show and cancellation policy, this is something to consider.

Another important component is actually enforcing this policy. If you created and communicated this to your clients, but haven’t actually ever enforced it, clients can begin to expect your flexibility regarding this all the time. Once you start sticking to it, they will begin to treat your time and sessions with all the respect it deserves. 

Here are some things to think about when you develop your policy.

Therapy Cancellation Policy: Set a Required Notice Period and Therapy No-Show Fee

How much advance notice would you like to have when a client needs to cancel or reschedule a session? 

Finding a happy medium between what you’d prefer and what you can reasonably expect from a customer in terms of notice is essential. Also, take into consideration how much time you might need to fill that appointment. For example, 24 hours. 

Plan for Unexpected or Urgent Situations with the Therapy Cancellation Policy

Unexpected events and emergencies can happen at any time, and even the most prepared clients can be caught off guard. How will you handle it if a client cancels at the last minute because they woke up with a fever, or if there is a big snowstorm overnight? Sometimes these things can happen, so you can expect to build in some reasonable exceptions. 

Clients Showing Up Late

If a client shows up late, will you still give them their full appointment time? 

Depending on how you book your sessions, there might be someone coming in one right after the next with no breaks in-between. If you run over with one because that person was late, it can mess up your entire day. Here, you can consider whether you’ll take a late client, and if their session will be shortened to still finish on time, or whether they’ll be charged and need to reschedule to another day. 

Determine How The Therapy Cancellation Policy Will Be Enforced

Once you’ve decided how you’d like to handle each of these situations, you can start to outline how the policy will be enforced. Let’s say you’ve decided to charge the full fee for no-shows and late cancellations, except in emergencies. To ensure that client’s know this can be enforced, they should be informed and consent to the policy and either hold a pre-authorized credit card on file or ask for a deposit prior to scheduling each session.

Implementing a Therapy No-Show and Late Cancellation Policy

Many therapists have no trouble notifying clients of their policies, but many can avoid actually enforcing it by charging fees. If you choose to adopt a policy on what to do when a client pulls away between sessions, consider the following tips below for implementing the policy effectively. 

Inform and Remind Clients of Your Therapy No-Show and Late Cancellation Policy

Repeated reminders of your cancellation policy are the best way to ensure that your clients will stick to it. The first time you talk to them, whether over the phone or online, is the perfect time to inform them of this. 

This information should be included on your intake and informed consent forms where clients sign at the end. Even if they’ve signed these forms, reviewing it with them at the beginning of your initial session can ensure that they’ve heard and understood what they are agreeing to. 

It’s also a great idea to offer gentle reminders by displaying it clearly on your website and at your office’s front desk where payments are made. If you use appointment reminders, it should be included there too.

Arrange Automatic Notifications to Reduce Therapy No-Shows

Sending reminders, like texts, emails, or phone calls, can help clients remember their appointments. These messages can be sent out at various times in the week leading up to the session so that clients can remember to cancel or reschedule within the acceptable window that you’ve chosen.

Notifications can be done by you or your office staff through phone or email to confirm appointments, but automatic systems now exist through EHR or booking systems which are HIPAA compliant. These reminders state the time and date, but avoid including any personal information that could be seen by a third party.

Avoid Keeping Clients Waiting

If you are always running late for your sessions, the clients might begin to expect that and start rolling in late as well. By being on-time, you can set the tone for them. Just like we expect them to respect our time, we should respect theirs as well since they’ve made the effort to be on time.

By honoring your clients' time, they’ll also feel more valued. This could help make them more inclined to show up promptly for appointments and continue returning to see you. 

What To Do with No-Show Clients Before Charging A Therapy No-Show Fee

When a client doesn’t show up for a scheduled appointment, it's understandable that all sorts of negative assumptions can go through your head. Rather than doing this, it can be helpful to reach out to the client to make sure they’re okay. If they don’t answer you can leave a voicemail or send an email to remind them of the missed appointment, ask about what may have happened, and express your concern. 

It's best to avoid jumping to conclusions about why they didn’t show up as they could have had an emergency and were unable to contact you. 

Here’s a sample follow up email for a no-show client:

Subject: Re: Missed appointment today

Hi [Client’s name],

I hope you’re doing well. I was expecting you for an appointment with me today at [time], and I waited patiently for you to arrive. I gave you a call and left you a voicemail to check in. I wanted to make sure nothing bad happened and that you are safe, please let me know. 

Hope to hear from you soon,

[Your name]

Ways To Avoid Cancellations and No-shows

The reality is that no-shows and late cancellations can’t be avoided entirely, but the frequency of them occurring can be minimized. 

Here are a few tips to reduce no-shows for therapy sessions that you can incorporate:

Don’t Schedule Too Far In Advance

No-show rates have been linked to the amount of time that passes between the day an appointment is booked and the actual meeting. 

To give you an idea, the average no-show percentage is almost double for therapy sessions booked two weeks in advance compared to 5 days. 

A lot of things can happen in a two week period, so it's understandable that people can forget or have other events come up. 

If you’ve been booking a month out in advance and have noticed those clients no-showing or canceling, it could help to stick to scheduling just 2-3 weeks ahead.

Adopt a Metrics-Based Approach to Therapy

Clients seeking mental healthcare can feel more empowered and engaged with therapy if they have tangible stats they can track their progress with. 

If they’re offered ways to measure their progress, this can promote introspection between sessions and have them eager to show up next time to discuss those thoughts.  

The structure provided by measurement-based care allows the clients to open up about their treatment objectives, successes, challenges, and potential adjustments without feeling awkward or undermining your skills. 

This strengthens the therapeutic bond, keeps clients interested, and increases the likelihood that they will appear for their appointments.

Recognize Trends in Therapy Client Cancellations and No-Shows

Private counseling practices can prevent no-shows by keeping track of patterns in client attendance. As a therapist, you can support your clients and practice by learning from the past or identifying the causes of occasional no-shows.

If a client fails to show up for an appointment, make sure to ask them about it. Observing their patterns can help you pinpoint issues and develop a workable solution. For instance, clients who make it to the first appointment but not the second might have some underlying issues that have to be addressed, such as:

• Delay in setting up a follow-up appointment
• Long waiting period
• Absence of reminders for appointments
• Poor service from the staff

One of the things to be considered is if there is room for improvement in how you and your staff interact with clients. 

What kind of attitude do your employees have toward them? Are they friendly and helpful? 

Your client’s impressions of their visit to your practice is heavily influenced by the reception they get from the staff. Those that receive courteous service and a warm, friendly attitude are more likely to have a positive view of the practice and will be likely to return. 

It’s also important to monitor a person’s no-show rate over time. If you see that a client consistently misses appointments on Wednesdays but never on Fridays, you can suggest that they book appointments on Fridays moving forward.

If a client has trouble keeping afternoon appointments but always arrives on time for morning ones, you can recommend coming in for morning appointments in the future. By looking for patterns in client behavior and adjusting to them, you can reduce the incidence of mishaps in scheduling.

Join The Cooperative for More Tips To Reduce No-Shows for Therapy Sessions

No-shows, late arrivals, and late cancellations are inevitable, and every mental health professional will experience this situation. 

By implementing the measures we’ve shared in this article, you can decrease the frequency of these occurrences. As a result, you’ll have more time to support your clients and less of it spent wondering if they’ll show up on time, or at all. 

You are welcome to join our community where therapists can openly ask questions and support each other with questions regarding implementing these policies. 

As you cultivate and grow your private practice, Clarity Cooperative is here to help you every step of the way.  We have a wealth of resources on our platform, from how-to’s to DIY guides, that we as therapists created to help you expand your business with confidence.