Revisiting My No-Cancellation Policy: 7 Years Later
Revisiting My No-Cancellation Policy: 7 Years Later
In 2018, I made a significant shift in my therapy practice by implementing a No-Cancellation Policy. I initially wrote about the rationale and mechanics behind this decision in a previous blog post, which I encourage you to read for context. Seven years later, this policy remains central to my work, shaping my approach to client relationships, financial stability, and overall business satisfaction.
If you're not familiar with my policy, here's a quick breakdown as written in my consent form:
No-Cancellation Policy: A commitment to our time together is essential for meeting your counseling goals. Missed appointments must be rescheduled during the week before, week of, or week after your absence. This provides a three-week window for rescheduling. Please use the online scheduler to manage cancellations and reschedules.
Session fees will be waived for two missed appointments per year, with no advance notice required. After two waived sessions, any additional missed appointments not rescheduled within the three-week window will incur a fee equal to your session rate. This fee is charged at the end of the rescheduling period and automatically applied to your credit card. Your appointment time remains secured unless I don’t hear from you.
What’s Working?
1. It Aligns with My Values
At the core of my therapeutic approach is accountability. The No-Cancellation Policy reinforces this by requiring clients to take responsibility for their appointments. This shared commitment fosters a deeper level of engagement in the therapeutic process, ensuring both therapist and client are on the same page about the importance of showing up.
2. Attracts Ideal Clients
This policy acts as a natural filter, attracting clients who are genuinely invested in their therapeutic journey. People who value consistency and accountability tend to thrive under this structure, which often leads to more productive and meaningful work. Clients who prefer less structure tend to filter themselves out before committing to therapy, making my client base more aligned with my therapeutic approach and fostering a more enriching experience for both of us.
3. Financial Stability
One of the policy’s biggest advantages is the financial stability it provides. Instead of losing income due to last-minute cancellations, I maintain a consistent revenue stream because missed sessions must be rescheduled or paid for. This equitable distribution of costs has had a profound impact on my business.
4. Simplified Administration
A key benefit of this policy is the elimination of the need to negotiate fees or decide whether a cancellation is "justified." My favorite part of the policy is that it removes decision-making around whether a reason is “good enough” to waive a fee. Two missed appointments are allowed per year, no questions asked. After that, any further absences are charged regardless of the reason. This takes the guesswork out of the equation, making the process transparent and efficient for both myself and my clients.
5. Enhanced Client Experience
Fewer cancellations often translate into greater momentum in therapy. This consistency fosters predictability and structure, which are crucial in maintaining the therapeutic rhythm. By nurturing this commitment to regular sessions, I prioritize accountability and ensure that the therapeutic process is both focused and intentional. Such an environment empowers both the therapist and the client to engage in deeper work without unnecessary interruptions. Ultimately, this approach not only enhances the client's experience but also significantly accelerates their progress in therapy.
6. Flexibility in Telehealth
Since I run a 100% telehealth practice, I also provide phone sessions for clients who can’t sit at a computer for 50 minutes. This flexibility has dramatically improved attendance, and to be honest, having a few phone sessions each week is great for me too—it gives me a chance to move around.
Considerations Before Replicating This Policy
1. Tracking Cancellations
While the policy itself is straightforward, it does require some administrative effort. I manually track cancellations and reschedules, which adds about 2-5 minutes of admin time each week. However, this is manageable and offsets the time I would otherwise spend negotiating cancellations or tracking down clients for unpaid fees.
2. Managing Client Schedules
Some clients have limited availability that doesn’t always fit neatly within my schedule. To accommodate this, I typically keep 1 vacant appointment slots per week for every 4 clients I see. This allows for reschedules to happen without overbooking. Most reschedules occur within the same week, so I’ve found that this buffer is usually more than enough.
If you're concerned about having empty spots, consider this: not booking every time slot can be a win-win situation. You can raise your fees to account for fewer clients, which balances out financially. Plus, you get the benefits of having extra time for case notes, marketing work, or even just a mental break.
3. Extended Absences
Clients occasionally need to take a few weeks off from therapy. If they’ve already used their waived sessions, I negotiate a compromise. I might give them extra time to reschedule, but I still require that they commit to as many sessions as possible. If they take more than two weeks off without updates, I explain that I can’t keep their file “open” and we proceed with a discharge. They can reach out when they’re ready to return, and we’ll start fresh from there.
Clinical Implications
1. Empowering Client Autonomy
This policy isn’t just about financial stability; it teaches clients to take responsibility for their therapeutic process. For clients who struggle with boundaries or accountability, having a clear structure around attendance provides an opportunity to practice these skills. One client, for example, shared how proud she was when she canceled a session without feeling the need to over-explain her reasons—a significant step in her personal growth.
2. Long-Term Commitment
Other therapists often wonder how long clients can maintain this kind of commitment. Because the policy and our work together focus on personal accountability and making stronger commitments to oneself, the policy never feels like a burden to them—it naturally fits with the commitment they are already making. Clients generally embrace the structure because it supports their own goals of personal growth and responsibility.
3. Dealing with My Time Off
I’ve had therapists ask how I handle time off under this policy—whether I’m expected to follow it myself. Here’s the truth: it’s my practice, and I set the rules. I give clients plenty of notice when I plan to take time off, and they adjust accordingly. If I need to cancel a session last-minute due to illness or an emergency, I simply do it. This is a business decision, not something I negotiate with my clients.
A client expecting me to never take time off or always be available doesn’t align with how I run my practice. If someone wanted to hire me with those kinds of restrictions, I wouldn’t take them on as a client. My schedule, like my business, is mine to manage.
Conclusion
The No-Cancellation Policy has been an essential part of my practice, allowing me to maintain stability, accountability, and a positive client experience. While there are challenges to implementing such a policy, I believe its benefits far outweigh any downsides. As my practice continues to evolve, I remain committed to refining and adapting the policy to ensure it supports both my business and my clients' therapeutic goals for years to come.
Key Takeaways:
Values Alignment: The policy reinforces personal accountability and responsibility in the therapeutic relationship.
Attracts Ideal Clients: Clients who are committed to therapy tend to naturally align with the structure of this policy.
Financial Stability: The policy ensures a consistent revenue stream by minimizing income loss from cancellations.
Clear and Simple: It eliminates the need for judgment calls or negotiating fees, creating a transparent and efficient process.
Long-Term Client Engagement: Clients typically embrace the policy as part of their ongoing commitment to personal growth.
Flexibility in Telehealth: Offering video and phone sessions has improved attendance and provided mutual benefits.
Managing Your Schedule: Keeping a few appointment slots open for reschedules, paired with potentially raising fees, allows for flexibility while maintaining financial health.
My Time Off is My Own: I set the rules for my practice, including when and how I take time off, ensuring I run my business on my own terms.
