I knew going into private practice I would have to expect some clients to cancel or reschedule. I certainly did not account for the high amount that did. I had planned for it before opening my practice by adding a cancellation fee to my consent form and by talking to clients about it. I find this to be quite effective in and of itself. However, there are some other tips I can share with you.
First of all, why do clients cancel or reschedule last minute? Is it that life gets in the way via personal illness, personal and family emergencies, a death in the family etc.? Or is there something a bit deeper to these last minute cancellations? Some clients may cancel their first appointment for fear of the unknown; however, this type of cancellation seems, at least in my opinion, to be rare. I find that mental illness itself may impede the client from making their appointment, especially when anxiety and depression come into play. If they can barely meet their activities of daily living, like showering and getting out of bed, how can they make it to your office? Other reasons people may cancel are due to a breach of some kind of the therapeutic alliance perceived by the client, a change of financial situation, having a phobia to come in or having some form of avoidance especially when diving into deep topics etc.,
Having a cancellation policy set up in your consent form, like I mentioned above, is a great first step to avoiding or cutting down on cancellations. Clients will think twice about cancelling last minute because a cancellation fee will apply. You can always give a first time warning as well if you are worried about breaking the therapeutic alliance. I believe that if you set the boundaries early about cancellations, clients will respect that and reschedule/cancel ahead of time to respect both your time and money. It is up to you what you will charge for cancelling last minute and what time frame you set. I tell clients that I prefer a 24 hour notice by email or phone but the fee will be applied if less than 12 hour notice is given. I personally charge half of my actual fee. At first, I wrestled with this notion of charging people for last minute cancellations. Then I began to realize that it is my time and my source of income and it’s a professional courtesy. If you are new to practice and you have a last minute cancellation – you may already have gotten ready for the day and be in the office and that may have been your only client. Can you justify the fee then? Many clients may not be aware that you pay for office rent, supervision, advertising, business supplies, etc., all out of pocket. This is a business decision that you need to decide is right for you. If you do decide to have a cancellation fee, will yours be flexible in certain circumstances?
Another way to encourage clients to remember their appointments- especially if they have the tendency to forget and not show up – is to suggest writing it down in a planner or using an appointment reminder app on their smart phone. There is also various tools that therapists can use to remind their clients of their appointments. I personally don’t send reminders or have used any of these applications; so the ones I suggest, I recommend you delve into a bit deeper if you are interested. Personally, I write their appointments down on my business card and if they have the tendency to forget I will send them a courtesy reminder. However, I haven’t had to do that very often for me to even consider an app.
https://www.appointmentreminder.org/ is a therapist tool offered online that will send out either text or phone reminders. They do have a 30 day free trial to see if this is something for you. Apptoto is another therapist tool that connects your google calender and sends text/phone reminders to clients. JustRemindIt and SchedgIt are Iphone apps and SMS appointment reminders app are for android phones. These are just to name a few. If an app is too technological for you personally, consider calling your client or emailing a day or two in advance.
A final tip is to deal with repeat offenders. If you have a client who is not abiding by your cancellation policy and continues to cancel last minute, perhaps it is time to discuss with them about why their cancelling and how it can be resolved. If this does not help, consider terminating with that client and provide a referral. These are issues that can be of course discussed in supervision or with a colleague for guidance and support. Do you deal with frequent cancellations and no-shows? How do you deal with it? What’s been helpful and what’s not been helpful?
Andrea Cashman is a private practice psychotherapist who has founded Holistic Counselling Services for individual clients seeking therapy in Ottawa, ON. She also practices at the Ottawa Hospital as a registered nurse. Feel free to comment below or contact her at [email protected] or visit her website at www.holisticcounsellingservices.ca
*The views expressed by our authors are personal opinions and do not necessarily reflect the views of the CCPA