No-Show Policy: The Dos and Don’ts of Client No-Shows in Your Private Practice
Do you have a no-show policy and process you uphold as a therapist?
*Last Updated 10/16/24
The clock ticks past the hour and your client isn’t there. You wait. You stare at the couch (maybe contemplate taking a nap) and your anticipation builds. Are they not showing up for their appointment?
It happens. People miss appointments. Heck, we’ve missed appointments. For some practices it happens often, clients not showing up or cancelling last minute, leaving the therapist stressed out and unable to really have a steady, continuity of care with clients. Other practices don’t have this happen often, but when they do, the scurry to figure out a solution, often on a case by case basis, which is also stressful for the clinician and the client.
Let’s look at how to reduce the stress, reduce the no-shows and help your clients know what to expect in therapy with you.
What to Do When Your Client Doesn’t Show Up to a Therapy Appointment
Creating a new response and way of handling things every time a client doesn’t show up to their appointment can become exhausting AND, if you have a group practice, it’s not scalable. Your clinicians need some protocols. Protocols help us with our anxiety, ensure we’re engaging with clinical outcomes in mind, and help us manage the business of our practices more smoothly. This also helps the client know what to expect during their time in therapy with you, creating a safe container for the therapeutic relationship.
First it’s good to remember, to take a moment. Too often people respond out of fear or worry. Their trauma response gets activated. You may be here because this just happened to you and you don’t know what to do.
Take a breath.
We are so glad you are here. Below we have listed some things for you to consider if you have a no-show—including what to do, what NOT to do, whether to charge for no-shows, and a sample no-show policy.
Protocols for Handling No-Show Appointments in Private Practice
DO Call the Client to Check on Them
Our clients well being is of the utmost importance. You never know if something happened to your client. Care about them first and call them. If they don’t answer, leave a message if you have permission to do so. If they never show up for a session, follow up with one more call at the end of the session time. If you’re concerned about the client, you may request a welfare check from the police.
Never assume you know the why. Part of our role as a therapist is to set aside our preconceived ideas when we observe and listen. Yes, we all have a bias and yes, you may be thinking you know why the client didn’t show up, but all of that is wasted energy. Reach out and care for your client first and don’t forget to document what you did.
DON’T Post on Facebook that Your Client No-Showed
It can be tempting to start scrolling on your phone and maybe even making a social mediate post. But don’t do it. “Chilling in the office, thankful my client no-showed and I can eat my lunch.” We have seen posts like this. Don’t post anything about your clients on Facebook, and keep their information private. You may think your social media profiles are only for your friends. People can screenshot your posts, and you never know if someone is connected to a client you see. We’re in a different profession where we just can’t afford to spout off our frustrations about work, as this creates privacy issues. If you need to vent, get someone you can consult with or talk to a colleague on the phone or in person. Just keep your client’s information off the internet.
DO Have a No-Show Policy that Charges for Missed Sessions
This should be in your informed consent and is easy to follow through on when you have a credit card on file, stored in the electronic health record. There are exceptions, and before you make one, it needs to be clear to you how you determine those exceptions. If your informed consent says you charge and you don’t, there’s not only a business/financial impact to you, but more importantly, there’s a break in the communication between you and the client. You want to have integrity in the boundaries you set with clients.
Informed consent is part of the therapeutic relationship and can impact outcomes as well. Don’t avoid the boundaries you’ve set. You can have difficult conversations and so can your clients. You’re ideally a safe relationship for them to practice with.
Do you have to charge for missed sessions?
You get to do what is right for your private practice. It all comes down to your privilege. Alternatives to charging for misses sessions is having a maximum allowed missed session, and charging a fee that accounts for those. In other words to cover the expense of a missed session, you can charge a slightluy higher rate on average. But that means you need to be good with your cash flow and set aside savings for when you have a no-show.
Some therapists also have chosen to change the frequency of sessions, offering intensives instead as to avoid the week to week risk of no-shows.
DON’T Go Into Fear Mode
A missed session doesn’t mean your practice will fall apart. Fear doesn’t help you, and in fact, it can be a huge distraction. You’re smart and capable. Go back to your marketing and business plan and make sure you have the financial plans in place to account for missed sessions. Your clients and you will get sick, take vacations, and have emergencies come up. Plan on it, save for it.
DO Pay Attention to Your Response
Do you feel relief? Why? This could speak to your work with your client or it could speak to your business as a whole. Evaluate your business processes and where there might be gaps in how you run your business and how it contributes to possibly more no-shows.
Don’t Let it Happen Again and Again
In Business School for Therapists, we have our clients do a caseload assessment. They look at who they still have open and see them. They evaluate not only the fees and frequency of services but also the outcomes. At some point, you may need to refer out or send a letter to close the case until they return and determine they want services in the future.
Each practice is unique in terms of timelines, but we find it good to conduct a quarterly review of your cases and see if no-shows are an issue with any clients. Also, address it in your session. But after so many no-shows, it may be determined that a referral is needed. For example, one group practice has a process where if there’s a no-show they call the client. They let the client know they’re still on the books for their recurring appointment. If a no-show happens the next week, they call, send a letter, and cancel future appointments until they hear from the client. Then, after two weeks, they close the chart and send a final letter to the client.
You get to determine the best timeline, but having this process in place can help you stay organized and ensure you’re reaching out to your clients after they no-show.
DO Analyze the Data
If you’re having repeated no-shows, this could be for a few different reasons. You may not be working with the right clients for your practice. This can be because of a lack of alignment in your marketing or because you aren’t providing a thorough consultation to determine fit. The data can also show you may not be clear about the scheduling expectations and needs of your practice. This happens in the first consult, the first session, and the informed consent.
There also may be some therapeutic issues happening. You might be struggling to form a connection with clients, or your process might not be paced well for the people you’re working with. Get some clinical supervision and consultation if this becomes a pattern.
ACTION ITEM:
Document your process for handling a no-show. If you have a group practice, go over it with your team as well.
How to Reduce No-Show Therapy Clients
Evaluate your marketing. Are you seeking to attract the right clients for your practice?
Review your initial phone consultation. Are you avoiding discussing fees and frequency thoroughly with your clients? Do you provide a solid assessment to determine fit?
Take a credit card from the beginning. Yes, over the phone at the initial consultation.
Get your informed consent and credit card authorization form signed prior to the session — at least 48 hours prior if possible. This gives you time to follow up with the client and confirm they’re attending the appointment.
Go over your informed consent in the first session and be clear about your policies. Having a credit card on file for my clients has helped so much that I literally can count on one hand how many no-shows I’ve had.
If a person understands your policies and continues to have issues, this doesn’t mean they’re not the right fit for therapy. Talk to the client. Seek to understand. Get consultation if needed.
Taking initiative in how you handle no-shows in your practice is another way we can improve outcomes for our clients. Post below how you handle no-shows in your practice.
Sample No-Show and Cancellation Policy
Your therapist has a limited caseload to ensure that there is time and energy to plan for your sessions and to ensure they can be fully focused on you and your needs, return phone calls, etc. If you need to cancel your session, please do so 48 hours in advance so that your clinician can waive your weekly session fee and have an option to schedule a client who is in need during that time. If you cancel after 48 hours or no-show, you will be billed for the session time at the full rate. If you have an emergency, please contact your clinician as soon as possible so that they can offer an alternative time or mode of treatment (phone or video), if available.
