Why I choose to coach using a Session Fee Policy rather than a Cancellation Policy

Do you have a one or two-day cancellation policy — or worse, a 24-hour or 48-hour cancellation policy — as a practitioner or clinician? 

If so, have you ever thought about how the language you use in your private practice is harming your client journey? The very nature of your existing policy leads to a rupture in the therapeutic alliance, causing clients to drop out from their client journey. 

Have you ever asked yourself if the language you’re using in your policy could be hurting your client attendance and limiting the growth of your practice?

If attendance is one of the best metrics to track as you’re building your practice — and I firmly believe it is — then your policies need to teach your clients to attend their sessions as part of their therapeutic journey. Subsequently, you minimise rescheduling, cancellations, private practice wastage, and admin time!

Having a cancellation policy in your practice, where you charge people if they cancel within a specified time of their booked appointment, essentially teaches people to cancel, instead of encouraging them to attend.

You’re telling them, “It’s okay to cancel…you just need to pay a fee to do it.” Close your eyes and imagine yourself booking in your client’s next appointment. Do you say any of the following statements?

1. We’d better get something booked in because my schedule fills up quickly;
2. You want to take this appointment because I won’t have availability if you don’t;
3. Let’s book this in, you can always call and cancel it if you don’t want it.

If you have said anything like this, just note that you have taught the client a) therapy doesn’t need to be a priority, b) the client isn’t a priority and c) it doesn’t really matter if they keep their appointment. Language matters.

Knowing this, why not create a policy that sets the expectation for your clients to teach them to attend their sessions, rather than teaching them to cancel or reschedule?

How? I’m glad you asked…

Cancellation Policy vs Session Fee Policy:

When it comes to your private practice policies, language matters.

Your current cancellation fees most likely feel like a punishment to your clients. (They have great reasons they can’t attend….so why would you charge them anyway?)

Or you might use emotion to enforce it. Have you ever said to yourself, “I’m happy to charge this fee to them.” (I know you have at least once!)

Instead of using emotional mind to decide your policy, I recommend implementing a session fee policy in your practice. If they book the session, they pay a fee — rather than if they cancel the appointment, they pay a fee.

To start using a policy like this, the practice changes the focus to get enthusiastically informed consent.

ACTION STEP:

Start here:

1. To get enthusiastically informed consent, clients must be fully aware they have the option of not attending their appointment. This means, if they are unsure that they can keep their appointment, they shouldn’t book it in. Leave it to them to call to find a session at their own convenience.
2. Next, don’t be afraid to take credit card details. These details will be charged if the client doesn’t attend. (We’ll talk about your exceptions later!)

These policies teach people to attend, rather than punishing them if they cancel.

Think of it this way: When you buy an item on Amazon, it charges your card immediately. The item is now yours. You can’t cancel it while it’s on the way to you.

When it comes to appointments, be like Amazon! Once your client books an appointment, that time slot is theirs and they’re committed. Make it your policy to seek out commitment of attendance for all sessions and minimise your acceptance of client cancellations.

Feel resistant to this idea? You’re not alone! Remember that it’s in everybody’s best interest that clients show up for their appointments — after all, they need to attend therapy if they’re going to get good clinical outcomes.

Your client also has a responsibility to you and the therapeutic relationship. It’s okay to let clients know you’re expecting them to be there. You’ve been holding that appointment slot for them, and you likely can’t fill it with someone else, because you have the right number of clients on your books — I know you have so many right now that you CAN likely fill it, but that’s not the point.

You can carry a smaller caseload if clients attend their scheduled therapy sessions regularly — or if you can fill the time slot, you’re paying for the administrative time and effort to do so, plus you must carry a larger caseload. Spoiler alert: This leads to practitioner burnout.

If they’re going to cancel, having a session fee policy ensures clients take responsibility for their own therapeutic journey. It helps people understand that they are paying for the session they’re booking — not the clinical service they’re receiving. It’s a different model than what you’re probably using now, and you do need to train or retrain people to think in these terms — but when you do, it can have enormous benefits for you and for your clients.

Also, keep in mind that using a session fee policy will help you find clients that are the right match for your practice. You want to attract people who are committed to change and are dedicated to showing up for themselves and following through on their responsibility to you as a clinician.

If you want to build a sustainable, stable practice, having a session fee policy that helps you attract these “best fit” clients” is one of the best moves you can make.

So how do you replace your current cancellation policy, and implement a new session fee policy? Here are some helpful tips.

How to Implement Your Session Fee Policy

To implement a new session fee policy, you first need to find all the places in your practice where you’re currently using the “cancellation fee” language.

Most likely, those terms are in a lot of places, and they’re built into many of your processes. Take these steps to find your cancellation fee language:

1. Look on your website 
2. Review your intake paperwork
3. Examine your email or SMS reminders

Do you use language in your appointment reminders that tell people they will be charged a cancellation fee if they cancel their appointment? If you currently have a cancellation policy, keep in mind that some of your clients will see an appointment reminder and use that as a trigger to cancel their booking.

It’s still fine to send out reminders, but remove the association that the reminders are to cancel. Instead, set the precedent that reminders are a courtesy. 

Create a plan to shift all your cancellation policy language to your new session fee policies, and make the changes all at one time.

When new people come into your practice, use the new intake paperwork and reminders.

Then pick a date (perhaps at the start of a new month, quarter, or year) and reach out to current clients to inform them of the new policy. When you see each client explain the policy to them. Example language could be:

“Our therapeutic journey is an important one. We place an emphasis on attending your appointments. Therefore, if you book in this appointment, we ask that you attend the session. If you are unable to attend in person, please organise to have this session via phone or video. If none of the options work, we will charge the card on file.”

Get documented consent from all new and existing clients, so they can make informed decisions about whether they will attend their appointments. You must have written or verbal permission to charge people for missed sessions (or charge at the time of booking).

Use Your Judgement About Enforcement

So what happens when people cancel, and either ask for a refund on their pre-paid appointment or ask you not to charge the card on file?

Use your discretion. If people say, “I had to get my cat neutered,” you know they could’ve planned for that in advance and not booked an appointment when they had a vet visit.

On the other hand, if there is a death in the family, you can use your judgment about whether to charge them. This is your practice and your policy, and you can choose to be flexible. You can offer people some wiggle room if they are cancelling for reasons other than avoiding therapy. 

You also have virtual options. If someone can’t make it into your office for some reason, you can offer a telehealth or phone visit. The client can choose that option, or not — but let them know they’ll pay for the session either way.

Also, consider whether the person is just avoiding therapy. Your session fee policy encourages people to work through roadblocks or issues in a healthy way, and not skip appointments because of avoidance.

Don’t be afraid to build compassion and empathy into your policy while still being consistent and assertive. You get to decide how you are going to be with enforcing your session fee policy.

Use your best judgment as cases arrive, and keep practising. I have no doubt that you’ll find the right balance and figure out what works for you and your clients to achieve good clinical outcomes through attendance.

How to Use a Session Fee Policy to Increase Attendance and Minimise Cancellations

Attendance is everything in private practice. Instead of punishing your clients for not attending their sessions by slapping them with a cancellation fee, establish a session fee policy to encourage them to attend their sessions.

It may be one of the best moves you make for your private practice in the new year — and your clients will get better clinical outcomes from your new policy, too.

Sign up here for our free cancellation policy course.