Why Should Counsellors and Psychotherapists Charge for Cancellations?

Many therapists, myself included, charge clients for missed or cancelled sessions. Some therapists always charge the full fee, some therapists only charge for cancellations with less than 24 hours' notice and other therapists have a range of different policies depending on whether the client is paying a full fee or a discounted rate for therapy. There are as many different policies as there are therapists and in the initial session the therapist will generally explain the rules for therapy including any cancellation policies that may be part of the therapeutic contract.

At some point during the therapy, it is almost certain that the client will, for whatever reason, have to cancel a session and at that point there is often an awkward moment where the therapist must remind the client that there may be a charge for cancellations. Money has an undeniable importance in the practice of psychotherapy, and as such it is important that psychotherapists approach the subject in a matter-of-fact way. The symbol of money in the therapy room can often be intimidating for both client and therapist in the same way that the topic of sexuality can be. This natural reticence to speak of money in the therapeutic setting may well be born in the transference and countertransference that exist between client and therapist. In order for the therapy to be successful the therapeutic relationship must be robust in such a way that the therapist does not allow him or herself to become held to ransom by a client who may choose not to attend and financially punish the therapist for unfavourable interpretations.

It has been suggested that it is unethical for a psychotherapist to become financially dependent on clients and it is certainly the case where a therapist must not take advantage of a client for financial gain (NAPCP Code of Ethics). That is not to say, however, that therapists should not charge their clients, nor that therapists should be independently wealthy so as to avoid such conflicts. It is rather that the therapist must be aware that the stability of their practice depends on their ability to pay rent, insurance, and supervision in addition to any other costs related to their practice before they ever take a wage. The costs involved in therapy must be clearly laid out for the client with a clear and transparent fee structure and details of how cancellations will be handled.

If, with that in mind, the therapist becomes hesitant to impose fees on a client for cancellations or other reasons stipulated in the contract, then they might also be worried that if they give an unpalatable interpretation that the client may take their money and find a different therapist. A therapist who has become so beholden to his or her clients cannot ensure that they operate from an ethical position and may find themselves colluding with the client rather than engaging in an effective therapeutic relationship.

Freud (1913) himself spoke of the need to throw off false shame and voluntarily name the price of his time. In this way, he also suggests that some of the resistances to therapy are unwound by securing appropriate payment for therapy. He suggests that non-payment by a client may lead to an unconscious (or even possibly conscious) resentment of the client by the therapist, while the waiving of fees by the therapist may interfere with the treatment by way of altering the transference of the client, impeding the development of the therapeutic relationship.

In terms of ethical and safe practice, counsellors and psychotherapists usually have a limited number of hours that can be used in a week to see clients. Many full-time therapists see a maximum of 20 to 25 clients per week with the rest of the working week taken up by preparation for sessions, supervision, research, reading, CPD courses and administrative tasks. This means that, for many therapists, they do not have an income other than the fees charged to clients and those fees must all be gathered in less than 25 hours of a 35 to 40 hour working week. The therapist reserves a specific time for the client each week and cannot simply take the next person in through the door in the event of a cancellation.

The relationship itself relies on the provision of a bounded and secure space within the therapist’s practice, in this way the therapeutic relationship differs significantly from other professional relationships. The provision of safe and effective therapeutic services within an ethical framework requires that therapists maintain a certain level of self-care which also includes an ability to ensure that they are not under any undue financial stress.

While many other professional services do not charge cancellation fees in the way that some psychotherapists do, certainly there may be charges for short-notice cancellations, but in many cases if you have to cancel an appointment with your dentist, your GP or even your solicitor, they will likely not charge you for the privilege if given sufficient notice. Due to the specific nature of the relationship in counselling and psychotherapy the charging of cancellation fees is an ethically responsible position to take as it helps to ensure the longevity of a therapist’s practice and their ongoing ability to provide safe and effective therapeutic services to clients.