Client Attendance Isn’t Just a Client Problem: What Barriers Really Say About Your Practice

Want to Listen to this instead of reading it?

If not....read on ----> 

Let’s talk about cancellations and reschedules.

Not the odd one-off when someone’s car breaks down or their kid spikes a fever. I’m talking about the pattern—the silent drifting, the “Sorry, work called me in,” or the mysterious vanishing act where you find yourself wondering, Did they ghost me or did I miss something?

It’s easy to blame clients. “They’re not committed.” “It’s financial.” “They weren’t ready.”

But here’s the harder truth: attendance is something the practice must teach. And many (yep, even the good practices) are subconsciously teaching disengagement.

We’re going to pull that apart. But first, when I talk about attendance and clients being committed and active client follow up, the clients I’m referring to are the ones where you the clinician said, “Tash, I think you should be in therapy and can benefit from it” and I said, “Yes, clinician, I see the benefit and I want to be here.” But for whatever the reasons [Hello Adulting!!!] the clients and the clinician do not focus on the actual attendance part.  It’s also important to remind you that a booking does not equal an attended appointment. 

Barriers Are Real. But They’re Also Revealing.

We recently ran a coaching strategy session on client barriers with my monthly Mastermind Group Coaching Clients, and here’s what came up again and again:

• “They cancelled because of work.”
  
• “They forgot.”
  
• “They’re waiting on a referral.”
  
• “They said they feel better.”
  
• “They couldn’t afford it.”
  
• “They just never rebooked.”
  

Sound familiar? These are the usual suspects. But here’s the kicker: these barriers aren’t new, and they’re not going away. So if you keep responding the same way—letting admin carry the awkward conversations, waiving cancellation fees, or assuming “therapy just wasn’t for them”—nothing changes for the clients or your practice.

Clinicians are not here to just acknowledge barriers. But instead, the role is to help challenge them.

You Can't Outsource Engagement

Here’s what came through loud and clear in our mastermind:

• Many clinicians don’t want to talk about fees or cancellations—they feel it’s “admin’s job.”
  
• Some don’t want to follow up when a client disappears—afraid of seeming pushy or untherapeutic.
  
• Others assume that if someone doesn’t attend, it’s because they’re “not ready for therapy.”
  

And yet—those same clinicians feel drained when half their day collapses due to cancellations (likely outside the cancellation policy), or when they’re stuck with clients who aren’t making progress because sessions are too spread out.

Practices can’t have it both ways.

You are allowed to have standards.
You are allowed to expect and ask for consistency.
And yes, you are allowed to have conversations about commitment [and avoidance]—without it being a rupture of the therapeutic alliance.

Teach Attendance instead of Cancellations

Let’s say it plainly: if someone cancels 3 out of 5 sessions, therapy’s not happening. Full stop.

So what do you do?

1. Name the pattern early.
   First session. Not fifth. Not after they cancel. First session:
   “It’s normal for life to get in the way—work, family, all of it. Let’s talk now about what might stop you from showing up. If we name it early, we can plan around it.”
   
2. Treat engagement as a skill.
   If your client has never prioritised themselves before, attending regularly is a stretch. Don’t just hope it clicks. Model it. Reinforce it. Make space for it.
   
3. Let admin be the backup, not the front line.
   If your team is calling clients weekly because of the gaps in the diary, something’s broken. The follow-up plan belongs in your session with the client, not your admin’s inbox.
   
   

Financial Barriers: Are We Being Honest About What’s Really Going On?

I’m not saying that there isn’t a financial crisis happening.  What I am saying is that folks are always and forever going to use a barrier of money.  So, I asked my clients to look at the data.  And one of our practitioners shared a killer insight: she ran the data. And guess what?

Most cancellation reasons weren’t due to cost. They were due to work, holidays, or just not prioritising therapy. Only a small percentage mentioned finances at all.

Money might be the reason we hear, but we need to consider that it’s not always the real barrier.

And even when it is—it’s a conversation worth having. Can the practice stagger appointments? [Hint: Not anywhere in the Medicare Guidelines does it say you MUST use all 10 individual sessions back to back]. Blend private and Medicare?  Reflection Question: How do you and the client build a plan that feels manageable and clinically sound?

If the clinicians avoid talking about money, your clients will be too.

Are You Delivering “Therapy Dumping”?

Here’s a phrase that came up in coaching: therapy dumping.

That vibe when the client is showing up irregularly monthly (maybe) but they aren’t yet into a maintenance stage of therapy and you’re mostly recapping last time, but like talk therapy maybe??? 

If they’re new to the service, this is a red flag.  They have reached out for a reason.  So, investigate.  Understand are they just there for that? If so, cool.  If not, something has to change!  If they’re long-term and stable, maybe that’s okay. But be honest: are they getting value? Are you reaching clinical satisfaction for those clients with no real direction or outcomes?

If the answer is no, it’s time to rethink how you’re setting up expectations for attending sessions.

Clinician Barriers Are Real, Too

Let’s not pretend this is just a client problem.

Clinicians cancel.
Clinicians avoid.
Clinicians struggle with boundaries and managing conflict.

That’s why for my practices we embed professional development through core competencies:

• Red/yellow/green client mapping
  
• First session checklists
  
• Scripts for barrier conversations
  
• And giving clinicians permission to slow down in session 1 (and 2, and 3...)
  

It’s not about being perfect—it’s about being proactive.

Final Thought: Attendance = Outcomes = Sustainability

If your clients are booking in, but not attending, they’re not progressing. If they’re not progressing, you feel frustrated in your role. If your team feels disheartened, your business suffers.

Attendance is the heartbeat of therapy. Treat it like it matters.

Because it does.

Want to Go Deeper?

I absolutely believe that if you're consistently waiving your cancellation fee, that you shouldn't have the policy to begin with.  Why? Well, if modelling is a thing that humans do and understand, then having a policy you don't enforce doesn't feel like very great modelling.  I'd rather you just say what happens instead "I'd like you not cancel, but you can."

If though, you are keen to learn how you can charge your cancellation fee, yes, even when the client has a good reason, then I recommend viewing my Free Course: Comfortably Collect Cancellation Fees.  This isn't just another platform where someone tells you to just charge the fee.  Nope, this is a whole different perspective that I can promise you - you haven't heard before.  Find out more >>HERE<<.