A therapist's reflection on cancellation fees

All worthy psychotherapists have, among others, a quality in common: they are sincerely dedicated to helping people. But moral work and earning money are not mutually exclusive for practical purposes. For all its reality that contradicts the laws of nature, earning money has become a need through the development of our society, and one is not less moral for wanting to survive. A corollary of this facet of our practice is that many, if not most, therapists will have a cancellation policy ― a statement of the minimum period of notice a client must give prior to an appointment to cancel it without being charged for it. Naturally, there are ethical and commercial questions about it, and in this article we shall examine some. At no time will I be judging whether we should or should not be charging cancellation fees, nor will I be supposing that either clients or therapists should have particular opinions of or responses to them. Rather, I will be exploring possible perspectives on them; do with these perspectives as you wish at your own discretion and risk.

We first must understand why cancellation fees exist. Cancellation fees are, at their core, for economic security. If as a client you are charged a cancellation fee, you are not being punished. They exist because, when a therapist sets an appointment for you, they are foregoing the opportunity to set an appointment for another client at that same time ― a client who may well have attended the appointment. By losing the appointment, the therapist loses an opportunity to earn income, which itself is necessary for them to continue to operate their practice. By requiring a minimum period of notice to cancel an appointment without charging, a therapist is ensuring that they either have enough time to find another client to attend at the appointment time, or that the sacrifice does not leave them with a loss of income. It is not a negative value judgement against the client. It is a logistical practice.

Additionally, there is a possible therapeutic corollary to cancellation fees. As a basis, understand that humans tend to make decisions based on consequences, perceived goals, and the perceived value of outcomes. When a client engages a therapist knowing that the cancellation policy exists, arguably they are more likely to be a client devoted to participating in the therapeutic process, because they know there is incentive to make all efforts to keep their appointments. Simultaneously, a cancellation policy is associated with a therapist's mindset of knowing their own worth and relatedly valuing their time, so there are more likely to be other signifiers of this in the way that they present to the public. A client may at least unconsciously note this and approach them if they are also devoted to the process. Inversely, if a therapist is too lax with boundaries and as a result does not have a cancellation policy, they may also not be particularly conscientious, and may therefore attract clients who are not earnest about self-development, while deterring clients who are. I make no judgement in any case; these are simply observations of how the mind works.

Now, some clients scoff at cancellation fees, arguing to the effect of: "with all the money that therapists make, surely one or two appointments cancelled in a week will not make a difference". This is a fallacy for three reasons. First, the cliché that therapists are inevitably wealthy is not true. While some make significantly more than the average income, depending on their actual role and qualifications, many (if not most) of us are not in that category. We are not necessarily poor, but once we subtract business expenses and time spent on maintaining the practice itself, our businesses are not as financially fruitful as you may be led to believe (not that profit should be our sole motivator). Second, sometimes a large number of clients cancel in a week for unrelated reasons: illnesses, emergencies, work, family matters, and otherwise. That sums to a significant portion of income lost. Third, being too lax with our finances risks becoming a "slippery slope". Accordingly, if we do not maintain a minimum income regularly, we are setting a psychological precedent for ourselves that we can safely accept less income each week; eventually, we may find that we have allowed ourselves to become too lax, lost too much income, and ultimately facilitated a detrimental effect on our practice's finances. As a nonetheless related tangent, I advise any clients of therapy to be aware of your practitioner's cancellation policy ― most will state this in the consent form which you are usually required to sign before commencing. I have been informed of instances of clients complaining that they were not made aware of the cancellation fees when they were charged, when there was literal written evidence that they agreed to the policy. There is no reason to sign a document without reading it first, so do so.

This considered, let us understand clients' grievances as well. Many clients, even those we assume are financially well, are confronting financial concerns. Psychotherapy may cost them significantly, but they are making the sacrifice for their wellbeing. Events outside of their control happen that prevent them from attending. Being charged for no benefit can have an impact on them, and ultimately may make it difficult for them to continue therapy for the full course. Is it more morally sound to make exceptions and waive cancellation fees out of empathy to clients in difficult or uncontrollable situations? Although I am not suggesting that money is the final basis for all decisions, therapists must also consider a larger issue. If a client terminates our services after having been charged for cancellation, either because they believe we have been insensitive (especially if they cancel due to an emergency) or because they can not afford to constantly be paying cancellation fees due to the uncertainty of how regularly they will be able to attend, we must ask: was the cancellation charge worth more than the client's future appointment fees and the goodwill and ongoing therapeutic relationship?

As such, like with all aspects of our life endeavours, we often need to use our discretion and qualitative judgement in deciding whether our rules are actually of benefit in each situation. We as therapists are working with people in their most vulnerable moments; the sheer variability of human experiences demands adaptability. With pressure to conform to "best practice", we must remember that norms are often created by us, and while they may have much utility, we are not infallible. Our capacity to use discretion is born of the same cognitive virtue that makes therapy what it is.