To charge . . . or not to charge
If you’re a therapist in private practice or even in some community settings, you’ve experienced the challenge of this decision. Many of us become accustomed to charging clients for therapy sessions or for their copays/deductibles when the client attends a session, even if we feel conflicted about the amount we charge or the amount insurance will pay for.
We recognize that we are service providers with a tremendous amount of training and education, even if we struggle with self-doubt - a common experience for sensitive therapists. We know we deserve to be paid for the services we provide - just as a speech pathologist or a hair stylist deserves to be paid for their services. Even if we’re not fans of capitalism, we understand that everyone needs to make money to live, and that includes us.
However, when we have a client who cancels a session late, it can suddenly feel veeeerry different.
Maybe your client is sick, maybe their kid is sick, maybe they got called into a work meeting they can’t skip, maybe their family’s summer schedule has thrown them off. Your client’s reason for canceling may be completely legitimate.
As highly sensitive therapists, we feel so much empathy with why they had to cancel. We really, truly understand the thousands of demands that pull on everyone’s time.
(This is definitely not to say that every late cancellation is legit. We’ve also all had those clients - the ambivalent, partly-in-mostly-out clients who use cancellations or no shows as a form of avoidance, not to mention those who use it to test boundaries. There are so many ways a client can play out their “stuff” in whether or not they even show up for therapy!)
So, we have a policy about late cancellations, and that policy usually says to charge the client if they cancel with less than x hours of notice.
But then you get the text from your client who’s late canceling, and you feel that sinking feeling in your gut. Your stomach starts to tie itself into knots.
You KNOW the late cancellation policy applies, but you feel guilty and worried about enacting it.
You didn’t actually provide therapy, so it’s not really fair to charge the client, is it?
Their reason for canceling makes total sense, so you’ll let it slide this time (And then . . . probably the next time and the next and the next.)
You’ve had to cancel for being sick before, so you should offer them the same courtesy, right?
What if they get mad at you?
What if they end therapy? Wouldn’t it be better for them to stay in therapy to continue getting help?
You know this client is struggling financially, so it feels terrible to charge them.
It can be so easy to come up with a million reasons why you should not charge the client. I know because I’ve wrestled with them too! Because we know clients’ inner worlds and struggles, it can feel especially hard to charge them when we know they’re dealing with financial challenges. And, those reasons may be completely valid.
And you (or your organization) have a policy about cancellations.
And you need to make a living.
And you may lose income if you don’t charge the client.
And your feelings of guilt, worry, and fear about how charging the client will affect them and your therapeutic relationship can get really big.
And you find yourself wrapped up in a torrent of emotions and thoughts, and it’s easy to lose your footing.
So, take a breath. It’s time to get grounded.
The next time you get that late cancellation notice and find yourself on this roller coaster of uncertainty:
Take a few minutes to do what is calming and grounding for you. I know, it’s annoying to hear your own advice, but you are allowed to not respond immediately. You’re allowed to do some self-care to get a bit more clear-headed. Especially as a highly sensitive therapist, it’s ok to delay our responses as we sort through all the stuff coming up for us.
Remember that it is ethical to have a late cancellation policy (as long as we inform clients about it). It’s even an industry standard. In fact, it’s a standard for many, many industries in our digital age when people may be flakier than ever. My hair stylist, dentist, and massage therapist all send out reminders that I’ll be charged if I cancel our appointment late. This is the norm in business today.
Remind yourself of the why behind the late cancel policy. In many settings, our income depends on the number of clients we see. We hold and guarantee each client’s appointment time for them. This means we can’t plan for a back-up session to still get paid if someone cancels. Thus, we need safeguards to protect ourselves, our time, and our livelihoods. Having good boundaries and holding to our policies also helps us manage our own emotions and can prevent frustration and resentment from building up toward our clients.
Practice that lovely compassion you show everyone else. I bet you understand if your hair stylist still charges you when you have to cancel late due to a client emergency. You might even encourage your stylist to charge you. You understand that this change affects their earnings and their schedule, even if you didn’t have much control over why you had to cancel. You don’t want them to be hurt by this last minute change. Yep, you deserve the SAME compassion, gentleness, and self-understanding.
Consider what options you have to improve your cancellation process, so you don’t have to work through this cascade of overwhelm every time. Some things that help me are:
Ensuring that I have clear language in my Informed Consent and my Credit Card Authorization about the policy
Going over the late cancel policy in each intake session
Including language in my appointment reminders about late cancellations
Waiving the 1st late cancel for a client and taking this as an opportunity to remind them that they will be charged for the next late cancel
Knowing that I have been clear, thorough, and reasonable in explaining the policy to clients verbally and in writing - even if they don’t remember or didn’t really take it in. (This really helps reduce my guilt.)
Tracking when I’ve waived a late fee and the frequency of late cancels. (The evidence reassures me.)
Being flexible with switching to phone or a telehealth session if something pops up fo a client who was planning to attend in-person but no longer can
Reviewing my schedule - to see if it fits within my regular work hours and number of clients I like to see per day - and offering another appointment time within the same week to the client. If I offer and the client reschedules, I explain that I won’t need to charge the late cancel fee because we can still meet within the same week
It also helps to think ahead of time about what valid exceptions are for you. Some criteria I reflect on are:
Have I waived a previous late cancel fee in the past year for this client? If yes, it’s feels much easier to charge.
Is this a long-term client, and does this client usually attend sessions consistently? If so, I may be more likely to waive a 2nd late cancel within a year, if it truly seems like a legitimate reason.
Does this matter seem like a genuine extenuating circumstance, like the client was hospitalized, there was severe weather that impacted the client’s ability to attend, or the client was extremely ill?
As highly sensitive therapists, exchanging money for our services will probably never be our favorite thing, and we likely won't ever enjoy dealing with late cancellations. All the money and boundary stuff kinda sucks sometimes.
But, I do know that we can be thoughtful and humane with implementing clear and kind boundaries that help protect our clients and ourselves. And, it’s ok if it’s hard.
Wishing you strength always and especially for the icky conversations,
