What does it mean when a client doesn’t show up for a session or cancels last minute?

When clients don’t show up, or cancel last minute it can inform how therapy is going.

It’s important to take the time to ask why the “no show” occurred. When I supervise other therapists I like to ask them to think deeply about what they think is going on.

Is it out of defense against the work (a Freudian take)? Or Perhaps a complex has taken over (the Jungian take)?
Alternatively, could it be as simple as the client flat out forgot or slept through their alarm?

Client’s cancel for all sorts of reasons.

Having been a client for many years myself, I can honestly say that most of the sessions I canceled last minute were due to forgetfulness (a symptom of my undiagnosed and untreated ADHD)…and there were a few last minute cancellations-and a few no-shows- in my younger years that were due to having stayed up too late the night before.

Interestingly enough, when I had to start paying privately for analysis I barely had any last minute cancellations. I am sure this was due partly to my inherent frugality-but it was also due to how much I enjoyed engaging in dream work and working symbolically with my psyche. Paying for my sessions myself seem to make the work even more valuable.

My life energy, transformed into money through work, was intentionally going towards further developing my relationship with myself. It is a very powerful experience to value yourself enough to pay another person to help you deepen your relationship with your self.

In my work as a psychologist, art therapist, and supervisor I have noticed a few patterns regarding last minute cancellations.

Why do clients cancel last minute or “no show”?

• They are sick.
• They are hung over.
• They doubled booked.
• They forgot about an exam.
• Their child is sick and they need to stay home with them.
• They were in a car accident that day.
• Someone has passed away.
• They woke up very tired or in a lot of pain.
• A beloved pet needs emergency veterinary care.
• They just got the email reminder for the session and are still in bed (they forgot).
• They forgot to turn their clocks ahead or back.
• The internet is down in their neighborhood (for online sessions).
• They got lost and couldn’t find the office (or parking).
• They didn’t do the homework they agreed to do for session and don’t want to confess this.
• They are having a good day and don’t want to go deeply into the work.
• There is something they are avoiding.
• They are scared/anxious.
• The therapist said something or did something to break trust.
• Therapy feels too overwhelming.

I am sure there are many more reasons why people make last minute cancellations, or miss sessions without notifying the therapist. These are just a few that I have witnessed in my practice.

How do you deal with a “no show” or last minute cancellation?

Personally, I have a pretty strict cancellation policy that all my clients are told about and consent to. They know that they can cancel within 48 hours and will not be penalized. If they cancel within 48 hours they will be charged the full price of the session unless the cancellation was due to an emergency (I include pet emergencies in this policy!).

I also try to rebook the session for later that day if I can. I am usually pretty booked up, but every once in a while I can manage to see someone later instead of charging them for a no-show.

*I also let clients know that I hold myself to the same standard. If I sleep through a session, or forget about a session I offer them a s

I always prefer to rebook if I can. Not only do I want the client to receive care, but I am often disappointed when a client cancels. I start my day by looking at my schedule, going over the notes of the clients I will see that day, and allowing myself to sink into a feeling of compassionate curiosity. When a client cancels it disrupts the flow of our work and leaves me with a feeling that something is unfinished.

I have heard that some therapists charge for a missed session regardless (emergencies or not!) and spend that hour thinking of the client and reviewing their files. I don’t find this very effective. There is no substitute for relationship, and of course responding to a clients last minute cancellation with empathy, understanding, and good boundaries helps the relationship grow.

However you decide to deal with last minute cancellations, or no shows, it is important to have a policy in place so that both you and the client know what the expectation is.

Interested in learning more about client cancellations? Cammi offers supervision to professionals and student therapists.