A client quit therapy last night because I charged her for a late cancellation. She felt I wasn’t “fair.” I like for clients to get their feelings out about late cancellation fees, and she definitely did. She felt I was seeing her “only as money.” She felt sad and hurt, and this has happened to her a lot.
Yet today a different woman gave me $220.00 for her late cancellation fees. She wasn’t angry; she saw it as a business arrangement. She knew about it, because the policy is written on each receipt and I tell everyone about it at the start.
But she’s a newer client. Over time, many clients start to see me as their listening friend. They maintain this illusion until an “emergency” comes up that runs afoul of my very clear cancellation policy. Each one voices their own complaints in their own way, but everyone feels it’s unfair and that they should be exempt due to their unique circumstances and because they’re “good” clients.
I don’t charge everyone every single time for late cancels. I make exceptions for events truly beyond my patient’s control – heart attack, babies born, parents death. I give the benefit of the doubt if there was any confusion about the time. I rarely ask people to move their sessions. And I give free sessions if I screw up and don’t show – something that’s happened only five times in my whole career, two on the same day.
But this doesn’t satisfy those who do have to pay for their late cancellation. Some write their feelings in their journal to get their money’s worth, often reflecting on why it is unfair. Some call me from strange and exotic places to have their appointment over the phone. And some come in and rant and rage at me – wanting me to hear them – then end up happy later, because it was the first time in their life someone let them get so angry and didn’t fight back, tell them they’re bad, or leave them.
So we go on next week having that issue settled. It is the calm after the storm; we can be truthful with one another. They know my boundaries, that I am not out to punish them, and that I will keep them safe and not abandon them just because they get emotional.
Usually the anger is more like fury. I hold on to my seat and try my best to let it ride past me. Of course they’re mad – they are bumping up against an injustice. In these moments, I am the police, the priest, or their father – whoever was unjustifiably firm with them. I am just one more unfair person, life victimizing them again. They think I am cold-hearted and only care about money.
I assure you, if I only cared for money, I’d be in another field. And I don’t get pleasure out of taking my client’s money in this way. I’d much rather they show up for the appointment. That would be the easiest solution for me. I’d like them to get some growth when they pay me.
And I agree that charging clients the full fee when they cancel less than 48 hours in advance is yet another of life’s great injustices. It is unfair when they couldn’t have predicted their dog would be sick, their boss would call a meeting, they put the appointment reminder in another purse, their car broke down, and so on and so forth. It is totally and completely unfair to them.
But I can’t pretend it doesn’t affect me. I’m not the Red Cross, Florence Nightingale, or the emergency center, getting funded elsewhere. I don’t earn money if I’m not working. It is unfair to me to have gaps in my schedule at the last minute because I can’t reschedule. From my end of the chair, I could have arranged my schedule differently also — perhaps bringing work-out clothes for that time, scheduled a lunch with a friend, or given that time to another client.
Of course, the real issue is whether it is good therapy to let them off the hook. Doing so would challenge the respect they show to their own process because it doesn’t invite them to look inside and take responsibility. These late-cancellations are a wonderful opportunity to explore how committed a person is to therapy as well as their relationship to money. I’m not helping anyone if I pretend that our commitment isn’t valuable and important to me. Enforcing the late cancellation charge is an invitation to reflect about how committed a person is to their own personal growth.
Besides, if our relationship was simply a business arrangement, and not a personal commitment, there would be no need to be angry.