Do you struggle to get to every one of your therapy sessions?

It's not unusual for busy people to miss therapy. Or, well, for anyone to miss therapy from time to time. Whether you've double-booked on appointment day, you have to study for a big exam, or you just don’t have the mental energy today, there are plenty of reasons why it doesn't always work.

But you might have noticed that you're still paying for your therapy appointment, even when you don't go. Is this normal or should you be worried?

Is It Normal to Charge For Canceled Therapy Sessions?

Yes, it's completely normal and very common for therapists to charge the full of the cost of a session if it's missed. So if you've not shown up and the money's come out of your bank, it's not a mistake!

If you do get charged, it's usually because you've canceled at short notice. For us at Aspire Counseling, our counselors consider short notice as anything less than 24 hours before the appointment. This is pretty standard for most psychotherapy practices and something we both list in our intake paperwork and try to go over with you at the start of therapy.

But, why do we charge, and is it fair to do so? Here are some of the main reasons that you'll still see a payment on your bank statement if you miss your counseling or therapy session.

Your Progress in Therapy Slows

The final reason for charging, and likely the most important, is because you lose out as the client. The truth is that therapy is hard work. However, as a practice that specializes in treating anxiety & trauma we’re very aware that avoidance maintains anxiety & trauma symptoms.

In other words, the more you avoid facing your anxiety or trauma the worse your symptoms will get. And we believe in the power of psychotherapy to help you overcome your symptoms and we believe you deserve to feel better.

While your reasons for missing counseling sessions are probably very valid, the truth is that something can always come up. There may be an underlying feeling of dread because counseling can make you feel uncomfortable. Operating under the surface is the feeling that not attending your session seems like the easier option.

But therapy provides much-needed support to help you feel better about your life and reach your goals. It may be uncomfortable at times, but you're doing something to help yourself grow, and that's so important! If you avoid your sessions, the anxiety you have about them is only going to get worse.

So, we want to give you every excuse we can to make your mental health a priority. We want to make coming into therapy as easy as possible and make neglecting your mental health or letting other priorities take the front seat more difficult. Because we believe that you can feel better than you do right now. Because we believe you deserve to make progress toward your goals.

The truth is, we charge for missed sessions because we want you to come, not just for us or for other clients, but for you. Every time you show up, you're investing in yourself, even when it can feel a little daunting. You're putting yourself first and we want to encourage that.

A special note about missing counseling appointments for anxiety & trauma….

At Aspire Counseling, we are perhaps best known for trauma therapy & counseling for anxiety. We know there are countless people living with anxiety or the aftereffects of trauma every single day. Held back by crippling fear, nagging anxious thoughts, self doubt & the effect of never knowing when you’ll be triggered. Honestly, I founded Aspire Counseling specifically to help people move forward after trauma and get free from their anxiety. I believe so deeply in the power of therapy to help you reach those goals, because I’ve seen it work over and over again. I’ve watched people who thought they’d never live a “normal” life again, never be able to return to college or never be able to fully enjoy specific situations again get better. And that is the single most powerful thing motivating me as a therapist myself and as the owner of Aspire Counseling.

But…in order to help people who are anxious or traumatized I know it’s critical that we do what works. That we use the plethora of research that’s been done to make sure we’re not just asking “how was your week” session after session but truly helping you dive in and make progress even when it doesn’t feel very good.

And honestly? Sometimes treating anxiety and trauma doesn’t feel good. Almost everyone wants to quit therapy at some point. And it often gets worse before it gets better. This will trigger in you an urge to avoid therapy.

Sure, your brain will come up with lots of “good” reasons to cancel that therapy appointment. And those reasons it provides are real. But so is your need to fully commit to facing this anxiety or your PTSD symptoms straight on. And to do that you have to be in therapy.

So, if you’re coming to us for anxiety or PTSD and you start canceling your appointments without consequence, I believe as therapists are hurting your chances to heal. Your brain starts to feel anxious about attending a therapy session, you cancel and you feel relief. So, of course your brain is more likely to throw a reason up for missing future appointments. But if you cancel at the last minute and we hold you responsible, it really emphasizes that your mental health is important. And hopefully, it encourages you to “avoid the avoiding” and make it regularly, consistently to your appointments which is what we know works when it comes to treating anxiety & trauma.

Your Therapist Misses Out

If you're missing therapy sessions, one of the reasons you might still be charged is because the therapist would lose out otherwise. Even if it's no fault of your own that you can't come, it's not the therapists', either. But if they don't charge you, they miss out on some of their weekly pay. 

It's unlikely they'll be able to find someone to fill the slot on such short notice, and they won't get paid regardless of whether you show up. They need you to pay in order for them to get paid. Our therapists decide how many clients they’ll schedule each week based on several different factors including the needs of their own family. So, if they have several clients who miss appointments and they don’t charge, they’ve now lost a big portion of the income they counted on having this week.

It's not just income that's a problem. Some of our therapists are considered full time and benefit eligible, so there is a specific number of paid client appointments they need to have in order to be considered full time and benefit eligible. While we’d love to offer benefits like health insurance free to all of our therapists, the truth is that there is a significant cost associated with those things. So, when clients don't show up and their number of paid counseling sessions per week drops, their “full time” status and therefore benefits could be affected.

It's normal as the client not to think of this huge effect that missing your appointment can have. But it's not just their paycheck that can be impacted, but their life outside of work, too. 

Our Other Counseling Clients Miss Out

You can't help being busy sometimes, but it is important to think about the other people who will be impacted when you miss therapy. That includes the other clients. 

We often have parents wanting to come in for parent sessions to discuss their child’s progress, clients looking for other open slots to reschedule a session or clients with pressing problems asking if we can fit in an extra session for a couple of weeks. If we're booked up, we can't help them when they need it.

But if someone cancels with enough notice, we call up clients in any of the scenarios above. Often, when we have a lot of notice that you’ll miss an appointment the therapist can fill the slot with someone else. Then, that other client gets the support they need in a timely manner.

If you don't cancel or you do it with just a few hours to spare, we can't fill the slot. That's another reason why therapists still charge for appointments. It's not just to get the payment, but to really discourage clients from canceling at short notice so that they can give the slot to someone who needs it.

But sometimes, you just have to cancel….

If you have other plans on the day of your therapy session, that's fine! Maybe you have a big exam that day, need time to unwind, or you have band practice. Whatever it is, we completely understand; you have to live your life, after all!

But we do need to know in advance. As soon as you know you can't make your session, just give your therapist a call (or email) to let them know as early as possible. We won't try to encourage you to come in or make you feel bad, we'll just say that's absolutely fine and see if we can rebook you for another time in the same week that works better.

As long as you cancel more than 24 hours before your therapy appointment, we won't charge you for the cost of your therapy. You won't be hurting us, you won't be hurting other clients, and hopefully we’ll find another time so your progress toward your therapy goals can continue. As long as we keep seeing you regularly and are able to help you reach your goals, it's all okay!

If you absolutely must cancel with less than 24 hours notice, we will charge you for all the reasons explained above. But we still want you to call so your therapist doesn’t worry about you. In some cases, our therapists will be able to reschedule you for another time in the same week and only charge you for one appointment since it will have less of an impact on both you and the therapist. However, most of our therapists have full caseloads and may not always have the flexibility to see you at another time that week.

Are You Looking For a Therapist?

If you're on the hunt for mental health support to help you work through any problems you're having, our counselors can help. We offer support for a wide range of issues including depression, anxiety, grief & trauma. At Aspire Counseling, we have an experienced and empathetic team that can help put you back on the right track. If you want to learn more, reach out to us today and we'll be happy to answer any questions you might have!

About the Author

Jessica Tappana is the founder of Aspire Counseling. She believes deeply in the power of psychotherapy to transform lives and help people create lives that they can truly be excited about. She’s watched countless clients come to therapy not even sure if it would be “worth it,” throw themselves completely into the process and then find amazing new ways to move forward in their lives happier than they ever thought they’d be again. This happens through providing evidence based therapy that balances the best available research (the reason we use therapies like DBT, EMDR, TF-CBT & others at our practice….and the reason we believe we shouldn’t make it easy for you to cancel your counseling sessions) with the needs of the specific client sitting in our office and the unique strengths of that individual therapist. Aspire Counseling prides itself on balancing all three of these aspects when we work with clients so that we’re providing truly evidence based mental health services. Jessica’s proud of the care provided at Aspire Counseling and passionate about empowering clients through hiring and then supporting only the best, most passionate mental health clinicians who truly share her vision.