Appointment cancelation

In Defense of a Strict Cancellation Policy

I’m the first to admit that before I started working as a counselor, I wasn’t very considerate to service providers regarding missing appointments. I felt like I could cancel when convenient, and the providers made so much money anyway, that it wasn’t an issue. I also figured many providers are just so busy that they will just pick up a new appointment right away. When working as an intern, I was forgiving about almost any reason for a client canceling or even not showing up without any communication. I later moved to give each client one free miss, because life happens. What I found was that misses rarely occur when a client is in the middle of therapy, but are usually the first or last appointment. And to be clear, a miss is considered a no-show without 24 hours’ notice. Clients sometimes sign up and then get cold feet (which is fine if you give notice that you changed your mind). Clients sometimes decide they have met their goals and just forget to cancel the last appointment or decide canceling is unnecessary. Professional couples may especially appreciate the value of their and others’ time. Some may cancel because they are not sure it is right for them.

In counseling (at least in private practice), full-time is considered seeing 20 clients a week. Time to write notes, plan sessions, conduct billing, run a business, marketing, continuous learning, and taking time for what can be an emotionally demanding profession make 20 clients a week a full-time job+. Counseling generally doesn’t pay well compared to just about any other master’s degree+ program, and counselors need to take care of their financial needs and families too. Even an initial appointment requires setting up clients in a computer system, reviewing their intake notes, and coming up with a plan. Sometimes new appointments require adjusting schedules or a special trip to the office that requires missing a kids activity. A late cancellation or no-show generally prevents someone else from being able to fill that slot. Most appointments require at least some degree of advance preparation that is wasted time if the client doesn’t show.

Telehealth options now make it easier for clients to still attend if they develop a sudden illness (please do not come to the office if you are contagious or don’t feel an obligation to do telehealth if you really don’t feel well). There are some situations that are just unavoidable, but please call if you can’t make it as a courtesy. I used to make exceptions for some circumstances, but then there is the issue of what is a valid exception and what is not? While I trust clients, some have admitted to me later that perhaps they said they were sick but were really drunk from a long night of partying the night before (do not drive to the office under any circumstances if you are under the influence of illegal drugs or alcohol, I am definitely not encouraging that). Some clients later admit that they just had a better offer come up that day.

Counseling is generally somewhat long-term, so I tend to think of it as like signing up a child for a sporting or other event. If your child is sick and misses practice or you are out of town, you do not get a partial refund. In the long run, if you make most of your appointments, things will generally work out. It is understood that some late cancellations are unavoidable (but you still have to pay :)) While the policy may sound harsh, I believe it is the fairest approach for most people and it is best to be black-and-white.

This post is admittedly boring and direct, and a client has yet to complain about the policy (although this policy is relatively new), but I figured it is better to be proactive. The cancellation policy is of course part of the disclosure all clients must sign after having read said document. Check out the page on fees for more general fee information.

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