Cancellation Policies

Not all professional service providers have a cancellation policy, and not all who have one enforce it. Your chiropractor may hang a sign saying that anyone cancelling with less than 24-hour notice will pay a fee, but will you actually be charged if you get stuck at work and cancel at the last minute? Maybe, maybe not.

Therapists are different. We all have cancellation policies, and we’re known for enforcing them. Why is this?

The reasons fall into two categories. The first relates to the therapist’s self-interest.

Doctors have hundreds of patients, some number of whom they will see any given week. If an appointment is cancelled, someone else is likely to take it. Even if it goes unfilled, things even out: slow weeks are followed by busy weeks.

A therapist, by contrast, may have 20 patients and expects to see them all every week. There’s no pool of additional patients to fill cancelled appointments. The next week, 25 patients aren’t going to walk through the door to make up for the previous week. Therapists charge for missed appointments because, otherwise, the fluctuations in income are difficult to weather.

The second category of reasons is clinical, relating to what is conducive to the patient’s progress.

Put very simply: You have a 3 pm appointment with your therapist. You don’t feel like going, but, because you’ll have to pay for the session either way, you show up. Showing up and talking about not wanting to be there is part of therapy. Not showing up is an impediment to therapy.

Is there a clinical reason that many therapists charge even for sessions missed due to reasons beyond the patient’s control? When Freud said, “There are no mistakes,” he meant that every failure of our conscious self is actually an aim successfully attained by our unconscious self. A fender-bender on the way to therapy is, arguably, no accident.

One more word here. The cancellation policy is a part of the therapeutic frame - all the rules about how therapy will be conducted (fee, schedule, location, length of session, etc.). These rules provide beneficial consistency, but they will sometimes chafe. When this happens, when the mutually understood rules become frustrating for the patient, the therapist has a clue that an important unconscious process has come into play.