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

Have you ever felt frustrated because a client canceled their appointment last minute? How about completely not showing up while you're already in the office?

While a client could be progressing well in therapy, 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 aggravating. 

When this happened in my practice, I felt that I might be causing this. I wondered if it was something I had done wrong, or if clients were just being disrespectful towards me. 

Well, I'm here to tell you that you're not alone. There are steps you can take, like I did, to lower the occurrence of these events and protect your time. 

Sometimes things come up and plans need to be changed. If you create a system to handle no-shows and late cancellations, it can help manage these issues. 

Why Do Clients Cancel Therapy Sessions?

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

Emergencies happen. Sometimes, clients can forget about another event or trip happening at the same time. Usually, they’ll have a valid reason for needing to reschedule or cancel sessions. Most of the time they are doing it with plenty of notice. Unfortunately, there are those that choose not to show up or reschedule at the last minute. These situations can be detrimental to themselves and you.

Clients that were frequently cancelling or not showing up became a real problem for my practice. If you haven’t already been enforcing a therapy no-show and late cancellation policy, it's time to start. I’ll go over how implementing this can save your business and sanity.

Therapy No-Show and Late Cancellation Policies

One of the best ways to decrease the occurrence of last minute schedule changes is to create a policy. Not only create one, but actually enforce it. 

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. Early in my practice, I would hold slots for clients that cancelled all the time. I didn't take a fee from them, and it negatively impacted my income. It's especially hurtful if you had another client that wanted to come at the same time. When creating my no-show and cancellation policy, I had to factor this in. 

Another important part is actually enforcing this policy. Creating a no-show policy alone isn't enough. If you haven't ever enforced it, clients can expect the flexibility from you all the time. Once I started enforcing it, clients began to treat my time and sessions with 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? 

It's important to find a happy medium. Think about what you'd like, and what you can reasonably expect from a client in terms of notice. Take into consideration how much time you need to fill a cancelled appointment. For example, in my practice, it is 24 hours. 

Plan for Unexpected or Urgent Situations with the Therapy Cancellation Policy

Unexpected events and emergencies can happen at any time. Even the most prepared clients can be caught off guard. How will you handle it if a client cancels last minute because they woke up with a fever? What if there is a big snowstorm overnight and roads are closed? Sometimes these things can happen. So, you should 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 no breaks in-between clients. 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. If so, will you shorten their session and finish on time? Or, will they 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 the policy. Let’s say you’ve decided to charge the full fee for no-shows, except in emergencies. To ensure that client’s know this can be enforced, they should be informed and consent to the policy. You can also hold a pre-authorized credit card on file or ask for a deposit before scheduling each session.

Implementing a Therapy No-Show and Late Cancellation Policy

Notifying your therapy clients of the policies is the easy part. Actually enforcing it and charging the fees is the hardest part. Consider the following tips so you can effectively implement a no-show and late cancellation policy. 

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

Reminding clients of your cancellation policy can help make sure your clients will follow 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. Clients can sign at the end to consent to the policy. Even if they sign these forms, it doesn't mean they understand or really read the content. You can review the forms with them at the beginning of your initial session. This way, you can ensure they understand what they are agreeing to. 

Another idea is to offer gentle reminders. You can do this 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 can help clients remember their appointments. Reminders can be through texts, emails, or even phone calls. These messages can be at various times in the week leading up to the session. This way clients can remember to cancel or reschedule within your policies timeframe.

Notifications can be sent manually by phone or email to confirm appointments. Automatic systems also exist through EHR or booking systems which are HIPAA compliant. These reminders state the time and date. They also void 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, your clients might begin to expect it. They could start rolling in late as well. By being on-time, you can set the tone for them. 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 motivate them to continue their therapy sessions and show up on-time. 

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

How do you feel 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. Also, 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. They could have had a real 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. You can affect the frequency of them occurring. 

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 appointments that are scheduled too far in advance. 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're booking a month or two in advance and noticing a lot of no-shows and cancellations, this may apply to you. It could help to sticking to scheduling 2-3 weeks ahead. 

Adopt a Metrics-Based Approach to Therapy

Clients that look for mental healthcare like to feel empowered and engaged. Offering them tangible stats can help them track their progress. If they're given a way to measure their progress, it can promote healthy introspection between sessions. If they realize they are improving, they can be more eager to show up for each session. 

The structure that measurement-based care give the client can help them open up more. They can identify treatment objectives, successes, challenges, and adjustments without feeling awkward. This strengthens the therapeutic bond. It also helps keeps clients interested and promotes consistency with therapy session attendance.

Recognize Trends in Therapy Client Cancellations and No-Shows

Private counseling practices can prevent no-shows by keeping track of client's attendance patterns. As a therapist, you can support your clients and practice by learning from the past. Patterns can help you identify 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, a client makes it to the first appointment, but not the second. This client 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 look at 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 first impressions of their visit to your practice makes a big difference. It's also 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. This will make them more likely to return. 

It’s also important to monitor a person’s no-show rate over time. Does your client consistently miss appointments on Wednesdays, but never on Fridays? You can suggest that they book appointments on Fridays moving forward.

If a client always shows up late in the afternoon, you can recommend morning appointments in the future. It's all about looking at patterns in client behavior and adjusting to them. You can reduce the incidence of hiccups in scheduling. 

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

No-shows, late arrivals, and late cancellations are inevitable. 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.